Healthcare Provider Details

I. General information

NPI: 1881272375
Provider Name (Legal Business Name): PRISCILLA YANEZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 MAXWELL AVE
EL PASO TX
79904-1559
US

IV. Provider business mailing address

4875 MAXWELL AVE
EL PASO TX
79904-1559
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7057
  • Fax: 915-757-1640
Mailing address:
  • Phone: 915-533-7057
  • Fax: 915-757-1640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1033440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: