Healthcare Provider Details

I. General information

NPI: 1194812990
Provider Name (Legal Business Name): LISA LORRAINE YEARWOOD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W MAIN ST ARTESIA VA CLINIC
ARTESIA NM
88210-3711
US

IV. Provider business mailing address

1700 W MAIN ST ARTESIA VETERANS CLINIC
ARTESIA NM
88210-3711
US

V. Phone/Fax

Practice location:
  • Phone: 505-746-3533
  • Fax:
Mailing address:
  • Phone: 609-668-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD053104L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: