MEDICARE: YVONNE JANICE CORCORAN D.O.M.

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	171100000X	Acupuncturist	821	NM

General Provider Information

NPI Number	:	1417915141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YVONNE JANICE CORCORAN D.O.M.

Provider Business Mailing Address
First Line	:	3909 JUAN TABO BLVD NE
Second Line	:	SUITE 7
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3992
Country	:	US
Telephone Number	:	505-288-2215
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 JUAN TABO BLVD NE
Second Line	:	SUITE 7
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3992
Country	:	US
Telephone Number	:	505-288-2215
Fax Number	:

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

Provider Enumeration Date	:	05/02/2006
Last Update Date	:	08/31/2010

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