Provider Demographics
NPI:1043191083
Name:WOMACK, YAQQIRA HANA-MICHELLE (NMD)
Entity type:Individual
Prefix:
First Name:YAQQIRA
Middle Name:HANA-MICHELLE
Last Name:WOMACK
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:HANA
Other - Last Name:WOMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5777 E MAYO BLVD
Mailing Address - Street 2:AZ PX SB 01-227
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-4502
Mailing Address - Country:US
Mailing Address - Phone:480-342-6677
Mailing Address - Fax:
Practice Address - Street 1:2055 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7507
Practice Address - Country:US
Practice Address - Phone:678-913-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ25-1935202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine