MEDICARE: JEANNINE A YELLOWHAIR

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	163WM0705X	Medical-Surgical Registered Nurse	RN132341	AZ

General Provider Information

NPI Number	:	1942351101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINE A YELLOWHAIR

Provider Business Mailing Address
First Line	:	2616 E BEVERLY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7052
Country	:	US
Telephone Number	:	480-710-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 E BEVERLY RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-7052
Country	:	US
Telephone Number	:	480-710-6306
Fax Number	:

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

Provider Enumeration Date	:	01/15/2007
Last Update Date	:	07/08/2007

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Directions to “ JEANNINE A YELLOWHAIR ” Practice Location

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