Provider Demographics
NPI:1396205928
Name:HAYTER, ROBIN (IBCLC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:HAYTER
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 1:9418 OAKMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5821
Mailing Address - Country:US
Mailing Address - Phone:505-400-7193
Mailing Address - Fax:
Practice Address - Street 1:7708 4TH ST NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6510
Practice Address - Country:US
Practice Address - Phone:505-924-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM55605174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM55605OtherSTATE ISSUED LICENSE