MEDICARE: MS. DOREEN A. YANNOTTA NP

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	363LA2200X	Adult Health Nurse Practitioner	RN065943	AZ

General Provider Information

NPI Number	:	1245294297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOREEN A. YANNOTTA NP

Provider Business Mailing Address
First Line	:	26828 N 57TH DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-1246
Country	:	US
Telephone Number	:	480-414-7256
Fax Number	:

Provider Business Practice Location Address
First Line	:	20414 N 27TH AVE
Second Line	:	SUITE 300
City	:	PHOENIX
State	:	AZ
Zip	:	85027-3250
Country	:	US
Telephone Number	:	623-879-6000
Fax Number	:

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	06/06/2012

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