Provider Demographics
NPI:1710329768
Name:POWELL, HEATHER CHRISTINE (RN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:CHRISTINE
Last Name:POWELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:CHRISTINE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4332 SANDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-1059
Mailing Address - Country:US
Mailing Address - Phone:575-791-3869
Mailing Address - Fax:
Practice Address - Street 1:4332 SANDSTONE DR
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-1059
Practice Address - Country:US
Practice Address - Phone:575-791-3869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69966163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant