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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN HIATT RD, LD

MEDICARE: MRS. MICHELLE LYNN HIATT RD, LD
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
1133V00000XRegistered DietitianNDP-2023-0085NM

General Provider Information

NPI Number : 1548058175
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN HIATT RD, LD
Provider Business Mailing Address
First Line : 8319 SAN GAVILON ST NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87113-2916
Country : US
Telephone Number : 575-491-2250
Fax Number :
Provider Business Practice Location Address
First Line : 2211 LOMAS BLVD NE
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87106-2719
Country : US
Telephone Number : 505-272-2111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2025
Last Update Date : 02/11/2026

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