Healthcare Provider Details

I. General information

NPI: 1174748438
Provider Name (Legal Business Name): DAVID WARD YEGERLEHNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 HOSPITAL DR
SANTA FE NM
87505-4743
US

IV. Provider business mailing address

1648 ALAMEDA BLVD NW
ALBUQUERQUE NM
87114-8807
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4848
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number9688
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: