Provider Demographics
NPI:1659648715
Name:YARBRO, TAWNYA MARIE (NM LMT #2737)
Entity Type:Individual
Prefix:MS
First Name:TAWNYA
Middle Name:MARIE
Last Name:YARBRO
Suffix:
Gender:F
Credentials:NM LMT #2737
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 921
Mailing Address - Street 2:
Mailing Address - City:FLORA VISTA
Mailing Address - State:NM
Mailing Address - Zip Code:87415-0921
Mailing Address - Country:US
Mailing Address - Phone:505-486-6976
Mailing Address - Fax:
Practice Address - Street 1:325 N BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-6927
Practice Address - Country:US
Practice Address - Phone:505-486-6976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMT #2737171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor