Individual
IDA WAGONER YAZZIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
Mailing address
500 INDIANA AVE, WINSLOW, AZ 86047-2169
(928) 289-4646
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
RN163776
AZ
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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