MEDICARE: DR. YVONNE D VANARSDALE-IMANI MD

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	207Q00000X	Family Medicine Physician	MD2004-0550	NM

General Provider Information

NPI Number	:	1861497901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YVONNE D VANARSDALE-IMANI MD

Provider Business Mailing Address
First Line	:	12231 ACADEMY RD NE
Second Line	:	STE 301-117
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-7236
Country	:	US
Telephone Number	:	515-778-8777
Fax Number	:	505-438-0590

Provider Business Practice Location Address
First Line	:	4504 4TH ST NW STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-3956
Country	:	US
Telephone Number	:	505-896-1222
Fax Number	:	505-896-1444

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	04/13/2021

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