Healthcare Provider Details

I. General information

NPI: 1891454732
Provider Name (Legal Business Name): SOPHIE HUFFMAN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/08/2021
Certification Date: 12/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 VASSAR DR SE
ALBUQUERQUE NM
87106-2922
US

IV. Provider business mailing address

1405 VASSAR DR SE
ALBUQUERQUE NM
87106-2922
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-0840
  • Fax:
Mailing address:
  • Phone: 505-977-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-120066
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: