Provider Demographics
NPI:1063231348
Name:YAZZIE, MARCELLA R
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:R
Last Name:YAZZIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2336
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-2336
Mailing Address - Country:US
Mailing Address - Phone:928-255-7689
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 2336
Practice Address - Street 2:
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-2336
Practice Address - Country:US
Practice Address - Phone:928-255-7689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-04
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider