MEDICARE: MISS DORCAS ANN YATES RN CFNP

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	363LF0000X	Family Nurse Practitioner	R15456	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85-0286828	OTHER	NM	FEDERAL TAX ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003889254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DORCAS ANN YATES RN CFNP

Provider Business Mailing Address
First Line	:	1010 E ROOSEVELT AVE
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2118
Country	:	US
Telephone Number	:	505-287-2948
Fax Number	:	505-287-5372

Provider Business Practice Location Address
First Line	:	1010 E ROOSEVELT AVE
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2118
Country	:	US
Telephone Number	:	505-287-2948
Fax Number	:	505-287-5372

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	12/07/2010

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