Individual
HEATHER ROSE CHARLIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCPT
Contact information
Practice address
1305 HUTTON AVE, FARMINGTON, NM 87402-7601
(505) 330-6953
Mailing address
1305 HUTTON AVE, FARMINGTON, NM 87402-7601
(505) 330-6953
Taxonomy
Speciality
Code
Description
License number
State
246RP1900X
Phlebotomy Technician
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
882876775
NURSING HOMES
NM
05
—
882876775
—
NM
Enumeration date
07/26/2022
Last updated
08/11/2022
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