Provider Demographics
NPI:1356465306
Name:YAHNER, MARIE A (L AC, MSOM)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:A
Last Name:YAHNER
Suffix:
Gender:F
Credentials:L AC, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16044 N 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053-4017
Mailing Address - Country:US
Mailing Address - Phone:602-721-0644
Mailing Address - Fax:
Practice Address - Street 1:16044 N 30TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053-4017
Practice Address - Country:US
Practice Address - Phone:602-721-0644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0526171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist