MEDICARE: HAILEY NICOLE YANEZ AT, LAT, ATC

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	2255A2300X	Athletic Trainer	ATTL-000106	AZ

General Provider Information

NPI Number	:	1629621164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILEY NICOLE YANEZ AT, LAT, ATC

Provider Business Mailing Address
First Line	:	7402 W AURORA DR
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-9615
Country	:	US
Telephone Number	:	623-889-1814
Fax Number	:

Provider Business Practice Location Address
First Line	:	5199 N 7TH AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2233
Country	:	US
Telephone Number	:	602-230-1600
Fax Number	:

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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