Provider Demographics
NPI:1982893798
Name:RISCHE, HEATHER JANE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JANE
Last Name:RISCHE
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 W ETHEL AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-1905
Mailing Address - Country:US
Mailing Address - Phone:575-523-4307
Mailing Address - Fax:
Practice Address - Street 1:1245 W ETHEL AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1905
Practice Address - Country:US
Practice Address - Phone:575-523-4307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02434-R175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61987832Medicaid