Provider Demographics
NPI:1760100606
Name:HEALTHY START PEDIATRICS LLC
Entity Type:Organization
Organization Name:HEALTHY START PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:LARA
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:575-224-2552
Mailing Address - Street 1:1745 AVENIDA DE MERCADO
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-4057
Mailing Address - Country:US
Mailing Address - Phone:575-224-5225
Mailing Address - Fax:575-224-6858
Practice Address - Street 1:1745 AVENIDA DE MERCADO
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-4057
Practice Address - Country:US
Practice Address - Phone:940-594-6415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty