Provider Demographics
NPI:1417915141
Name:CORCORAN, YVONNE JANICE (DOM)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:JANICE
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3992
Mailing Address - Country:US
Mailing Address - Phone:505-288-2215
Mailing Address - Fax:
Practice Address - Street 1:3909 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE 7
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3992
Practice Address - Country:US
Practice Address - Phone:505-288-2215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM821171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist