Individual
MS. THERESA A YAZZIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
24276 166TH ST. AIRPORT RD, EAGLE BUTTE, SD 57625
(505) 860-8927
Mailing address
194 ELK DRIVE, EAGLE BUTTE, SD 57625
(505) 860-8927
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
L1741
NM
Other
Enumeration date
03/26/2013
Last updated
03/26/2013
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