Healthcare Provider Details

I. General information

NPI: 1164913570
Provider Name (Legal Business Name): MS. SHARON YAZZIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 03/03/2022
Certification Date: 03/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W NIZHONI BLVD STE A
GALLUP NM
87301-5766
US

IV. Provider business mailing address

300 W NIZHONI BLVD STE A
GALLUP NM
87301-5766
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-9202
  • Fax: 505-722-9570
Mailing address:
  • Phone: 505-722-9202
  • Fax: 505-722-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: