Healthcare Provider Details

I. General information

NPI: 1003889254
Provider Name (Legal Business Name): DORCAS ANN YATES RN CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 12/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E ROOSEVELT AVE
GRANTS NM
87020-2118
US

IV. Provider business mailing address

1010 E ROOSEVELT AVE
GRANTS NM
87020-2118
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-2948
  • Fax: 505-287-5372
Mailing address:
  • Phone: 505-287-2948
  • Fax: 505-287-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR15456
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: