Healthcare Provider Details

I. General information

NPI: 1417730185
Provider Name (Legal Business Name): HEATHER BINGHAM RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3907 E BRONCO TRL
PHOENIX AZ
85044-2604
US

IV. Provider business mailing address

3907 E BRONCO TRL
PHOENIX AZ
85044-2604
US

V. Phone/Fax

Practice location:
  • Phone: 602-301-5145
  • Fax:
Mailing address:
  • Phone: 602-301-5145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN112510
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: