Healthcare Provider Details

I. General information

NPI: 1104749043
Provider Name (Legal Business Name): MELISSA ROTTSCHAFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 N BUTLER AVE STE 5101
FARMINGTON NM
87401-2392
US

IV. Provider business mailing address

4001 N BUTLER AVE STE 5101
FARMINGTON NM
87401-2392
US

V. Phone/Fax

Practice location:
  • Phone: 505-326-2791
  • Fax:
Mailing address:
  • Phone: 505-326-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberSAH-2026-0238
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: