Healthcare Provider Details

I. General information

NPI: 1417828393
Provider Name (Legal Business Name): LAURA YANEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 MCNUTT RD
SANTA TERESA NM
88008-9621
US

IV. Provider business mailing address

757 MONTE VISTA AVE
CHAPARRAL NM
88081-7621
US

V. Phone/Fax

Practice location:
  • Phone: 575-882-6101
  • Fax:
Mailing address:
  • Phone: 915-867-4008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN-79906
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: