Healthcare Provider Details

I. General information

NPI: 1821916172
Provider Name (Legal Business Name): REBECCA YAZZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 GIBSON BLVD SE
ALBUQUERQUE NM
87108-5566
US

IV. Provider business mailing address

1521 EASTRIDGE CT NE
ALBUQUERQUE NM
87112-4507
US

V. Phone/Fax

Practice location:
  • Phone: 505-254-4529
  • Fax:
Mailing address:
  • Phone: 505-688-9704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number68026
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: