Provider Demographics
NPI:1629621164
Name:YANEZ, HAILEY NICOLE (AT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:HAILEY
Middle Name:NICOLE
Last Name:YANEZ
Suffix:
Gender:F
Credentials:AT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 W AURORA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-9615
Mailing Address - Country:US
Mailing Address - Phone:623-889-1814
Mailing Address - Fax:
Practice Address - Street 1:5199 N 7TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-2233
Practice Address - Country:US
Practice Address - Phone:602-230-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZATTL-0001062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer