Healthcare Provider Details

I. General information

NPI: 1285341958
Provider Name (Legal Business Name): YVONNE HALL BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2022
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 YALE BLVD SE # F
ALBUQUERQUE NM
87106-4228
US

IV. Provider business mailing address

7224 TRICIA RD NE
ALBUQUERQUE NM
87113-1792
US

V. Phone/Fax

Practice location:
  • Phone: 505-526-5517
  • Fax:
Mailing address:
  • Phone: 505-264-5789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: