Healthcare Provider Details

I. General information

NPI: 1508685330
Provider Name (Legal Business Name): NATALIE HECKROTH RNC, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE STE 5620
ALBUQUERQUE NM
87106-2729
US

IV. Provider business mailing address

201 CEDAR ST SE STE 5620
ALBUQUERQUE NM
87106-2729
US

V. Phone/Fax

Practice location:
  • Phone: 505-841-1773
  • Fax: 505-563-6307
Mailing address:
  • Phone: 505-841-1773
  • Fax: 505-563-6307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberR44154
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: