Provider Demographics
NPI:1689813032
Name:YELDER, MARILYN (NP)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:YELDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:
Other - Last Name:NEGRON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7500 N DREAMY DRAW DR STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85020-4668
Mailing Address - Country:US
Mailing Address - Phone:480-882-4545
Mailing Address - Fax:480-692-6874
Practice Address - Street 1:4131 N 24TH ST STE B102
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6231
Practice Address - Country:US
Practice Address - Phone:480-882-4545
Practice Address - Fax:602-903-7091
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN154374363LP0200X
AZAP3258363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ623525Medicaid