Healthcare Provider Details

I. General information

NPI: 1073046405
Provider Name (Legal Business Name): GLORIA VIERA RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5224 IRONWOOD DR NW
ALBUQUERQUE NM
87114-4628
US

IV. Provider business mailing address

5224 IRONWOOD DR NW
ALBUQUERQUE NM
87114-4628
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-8590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR55986
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: