Healthcare Provider Details

I. General information

NPI: 1386273589
Provider Name (Legal Business Name): MARGARET L. SELENA YEARWOOD APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 04/08/2020
Certification Date: 04/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14412 N 9TH ST
PHOENIX AZ
85022-4367
US

IV. Provider business mailing address

14412 N 9TH ST
PHOENIX AZ
85022-4367
US

V. Phone/Fax

Practice location:
  • Phone: 602-920-8363
  • Fax:
Mailing address:
  • Phone: 602-920-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number240073
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: