Provider Demographics
NPI:1194812990
Name:YEARWOOD, LISA LORRAINE (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LORRAINE
Last Name:YEARWOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 W MAIN ST
Mailing Address - Street 2:ARTESIA VETERANS CLINIC
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-3711
Mailing Address - Country:US
Mailing Address - Phone:609-668-4154
Mailing Address - Fax:
Practice Address - Street 1:1700 W MAIN ST
Practice Address - Street 2:ARTESIA VA CLINIC
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-3711
Practice Address - Country:US
Practice Address - Phone:505-746-3533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053104L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine