Healthcare Provider Details

I. General information

NPI: 1518034800
Provider Name (Legal Business Name): BARBARA YELLOWHAIR RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 N 16TH ST
PHOENIX AZ
85016-5319
US

IV. Provider business mailing address

PIMC 4212 NORTH16TH STREET
PHOENIX AZ
85016
US

V. Phone/Fax

Practice location:
  • Phone: 602-263-1557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License NumberRN074382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: