Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | 55425 | NM |
N | 225700000X | Massage Therapist | MA51432 | FL |
N | 225700000X | Massage Therapist | MT9150 | NM |
NPI | 1144864778 |
---|---|
Provider Name | Christina Averhart |
First Address | Rio Rancho, NM 87144-5686 |
Second Address | Albuquerque, NM 87109-3357 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2019 |
Last Update Date | 06/11/2019 |