Healthcare Provider Details

I. General information

NPI: 1710329768
Provider Name (Legal Business Name): HEATHER CHRISTINE POWELL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS HEATHER CHRISTINE HUNT

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4332 SANDSTONE DR
CLOVIS NM
88101-1059
US

IV. Provider business mailing address

4332 SANDSTONE DR
CLOVIS NM
88101-1059
US

V. Phone/Fax

Practice location:
  • Phone: 575-791-3869
  • Fax:
Mailing address:
  • Phone: 575-791-3869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number69966
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: