Healthcare Provider Details

I. General information

NPI: 1588421481
Provider Name (Legal Business Name): NADIA K HEFFNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12129 N STATE HWY 14 STE 12C
CEDAR CREST NM
87008-9492
US

IV. Provider business mailing address

9 TUNGLEY WOOD
ESTANCIA NM
87016-8501
US

V. Phone/Fax

Practice location:
  • Phone: 505-600-9599
  • Fax: 224-632-1738
Mailing address:
  • Phone: 505-600-9599
  • Fax: 224-632-1738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2024-0005
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: