MEDICARE: GRETCHEN S FUTEY IBCLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174N00000X	Lactation Consultant (Non-RN)	10968297	NM

General Provider Information

NPI Number	:	1447684238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN S FUTEY IBCLC

Provider Business Mailing Address
First Line	:	4937 BLACK DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-4426
Country	:	US
Telephone Number	:	505-293-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	4937 BLACK DR NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87120-4426
Country	:	US
Telephone Number	:	505-293-5215
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2013
Last Update Date	:	08/01/2014

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