Provider Demographics
NPI:1003889254
Name:YATES, DORCAS ANN (RN CFNP)
Entity Type:Individual
Prefix:MISS
First Name:DORCAS
Middle Name:ANN
Last Name:YATES
Suffix:
Gender:F
Credentials:RN CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1010 E ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2118
Mailing Address - Country:US
Mailing Address - Phone:505-287-2948
Mailing Address - Fax:505-287-5372
Practice Address - Street 1:1010 E ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2118
Practice Address - Country:US
Practice Address - Phone:505-287-2948
Practice Address - Fax:505-287-5372
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMR15456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM85-0286828OtherFEDERAL TAX ID
NM44636Medicaid
NMG0667Medicaid
NM44636Medicaid
NMG0667Medicaid