1427615038 NPI number — MRS. SHALENE CYNETTA YAZZIE PA-C

Table of content: MRS. SHALENE CYNETTA YAZZIE PA-C (NPI 1427615038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427615038 NPI number — MRS. SHALENE CYNETTA YAZZIE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAZZIE
Provider First Name:
SHALENE
Provider Middle Name:
CYNETTA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427615038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 368
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KAYENTA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86033-0368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-697-4112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
394.3 US-160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAYENTA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-697-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  8155 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com