Provider Demographics
NPI:1174000145
Name:WINSTEAD-HEINECKE, CRYSTAL (IBCLC)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:WINSTEAD-HEINECKE
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 E HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-3422
Mailing Address - Country:US
Mailing Address - Phone:480-442-8491
Mailing Address - Fax:
Practice Address - Street 1:8400 S KYRENE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-2100
Practice Address - Country:US
Practice Address - Phone:480-442-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL-132313174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN