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General NPI Number Information
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NPI Number | 1164941621
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Entity Type | Individual
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Provider Name | JOHANNAH RENEE YAZZIE CPNP-PC
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Gender | Female
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 85 W HIGHWAY 22
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City | SANTO DOMINGO PUEBLO
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State | NM
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Zip | 87052-1283
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Country | US
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Telephone | 505-465-3060
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Fax | 505-591-0304
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Provider Business Mailing Address
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Address Line | PO BOX 340
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City | SANTO DOMINGO PUEBLO
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State | NM
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Zip | 87052-0340
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Country | US
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Telephone | 505-465-3060
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Fax | 505-591-0304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | CNP-03377
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License Number State | NM
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