Healthcare Provider Details

I. General information

NPI: 1356465306
Provider Name (Legal Business Name): MARIE A. YAHNER L. AC, MSOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16044 N 30TH AVE
PHOENIX AZ
85053-4017
US

IV. Provider business mailing address

16044 N 30TH AVE
PHOENIX AZ
85053-4017
US

V. Phone/Fax

Practice location:
  • Phone: 602-721-0644
  • Fax:
Mailing address:
  • Phone: 602-721-0644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0526
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: