Healthcare Provider Details

I. General information

NPI: 1679795785
Provider Name (Legal Business Name): YVETTE ELIZABETH FIELDS P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 PAN AMERICAN FREEWAY NE SUITE 330
ALBUQUERQUE NM
87109-3427
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 505-856-2735
  • Fax: 505-856-2749
Mailing address:
  • Phone: 858-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number97PA07
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: