1366566242 NPI number — MRS. RENEE CHRISTINE HEACOX-WINBORN LISW

Table of content: MRS. RENEE CHRISTINE HEACOX-WINBORN LISW (NPI 1366566242)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366566242 NPI number — MRS. RENEE CHRISTINE HEACOX-WINBORN LISW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HEACOX-WINBORN
Provider First Name:
RENEE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HEACOX
Provider Other First Name:
RENEE
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LISW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366566242
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 S TIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DEMING
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88030-3645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-694-5478
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 W HEMLOCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DEMING
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88030-3622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-694-5478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I-06900 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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