MEDICARE: TINA YAEGER RN, LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN82833	NV
2	225700000X	Massage Therapist	NVMT.6404	NV

General Provider Information

NPI Number	:	1003356833
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA YAEGER RN, LMT

Provider Business Mailing Address
First Line	:	4575 DEAN MARTIN DR
Second Line	:	#3009
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-8218
Country	:	US
Telephone Number	:	734-735-5353
Fax Number	:

Provider Business Practice Location Address
First Line	:	4575 DEAN MARTIN DR
Second Line	:	#3009
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-8218
Country	:	US
Telephone Number	:	734-735-5353
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2017
Last Update Date	:	02/27/2017

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