MEDICARE: MARY ELIZABETH YUTZY CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R48157	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558352898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH YUTZY CNP

Provider Business Mailing Address
First Line	:	933 BRADBURY DR SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4374
Country	:	US
Telephone Number	:	505-272-3120
Fax Number	:	505-272-8060

Provider Business Practice Location Address
First Line	:	2600 MARBLE AVE NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-2058
Country	:	US
Telephone Number	:	505-272-6907
Fax Number	:	505-272-9843

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	06/27/2012

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