Provider Demographics
NPI:1548811698
Name:YANEZ, TINA MARIE (QP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:YANEZ
Suffix:
Gender:F
Credentials:QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HIBBING
Mailing Address - State:MN
Mailing Address - Zip Code:55746-3609
Mailing Address - Country:US
Mailing Address - Phone:218-262-6675
Mailing Address - Fax:
Practice Address - Street 1:1309 E 40TH ST
Practice Address - Street 2:
Practice Address - City:HIBBING
Practice Address - State:MN
Practice Address - Zip Code:55746-3609
Practice Address - Country:US
Practice Address - Phone:218-262-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator