Provider Demographics
NPI:1750674149
Name:YAZEVAC, TAMMY LOU (PA)
Entity Type:Individual
Prefix:MISS
First Name:TAMMY
Middle Name:LOU
Last Name:YAZEVAC
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:900 FAIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26501-3847
Mailing Address - Country:US
Mailing Address - Phone:304-598-2233
Mailing Address - Fax:304-296-1792
Practice Address - Street 1:1370 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-1492
Practice Address - Country:US
Practice Address - Phone:304-842-7186
Practice Address - Fax:304-842-2533
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2015-07-10
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Provider Licenses
StateLicense IDTaxonomies
WV273363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant