Healthcare Provider Details

I. General information

NPI: 1396210696
Provider Name (Legal Business Name): MS. HEATHER RENE ALTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3825 EUBANK BLVD NE
ALBUQUERQUE NM
87111-3575
US

IV. Provider business mailing address

10009 LEXINGTON AVE NE
ALBUQUERQUE NM
87112-1506
US

V. Phone/Fax

Practice location:
  • Phone: 800-640-3451
  • Fax:
Mailing address:
  • Phone: 505-259-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number54103
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: