Provider Demographics
NPI:1447684238
Name:FUTEY, GRETCHEN S (IBCLC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:S
Last Name:FUTEY
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 BLACK DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-4426
Mailing Address - Country:US
Mailing Address - Phone:505-293-5215
Mailing Address - Fax:
Practice Address - Street 1:4937 BLACK DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-4426
Practice Address - Country:US
Practice Address - Phone:505-293-5215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM10968297174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN