Provider Demographics
NPI:1861497901
Name:VANARSDALE-IMANI, YVONNE D (MD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:D
Last Name:VANARSDALE-IMANI
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12231 ACADEMY RD NE
Mailing Address - Street 2:STE 301-117
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7236
Mailing Address - Country:US
Mailing Address - Phone:515-778-8777
Mailing Address - Fax:505-438-0590
Practice Address - Street 1:4504 4TH ST NW STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-3956
Practice Address - Country:US
Practice Address - Phone:505-896-1222
Practice Address - Fax:505-896-1444
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2004-0550207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMG96733Medicare UPIN