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General NPI Number Information
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NPI Number | 1225822521
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Entity Type | Individual
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Provider Name | DIANNE HEATON
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Gender | Female
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Dates
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Enumeration Date | 04/09/2025
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 6000 UPTOWN BLVD NE STE 140
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-4157
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Country | US
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Telephone | 505-305-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 OFFICE COURT DR STE 602
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City | SANTA FE
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State | NM
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Zip | 87507-4929
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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