Provider Demographics
NPI:1730514977
Name:WALSTON, YVONNE WYLIE (DOM)
Entity type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:WYLIE
Last Name:WALSTON
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2817 ESPANOLA ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3522
Mailing Address - Country:US
Mailing Address - Phone:505-604-5593
Mailing Address - Fax:
Practice Address - Street 1:2900 LOUISIANA BLVD NE
Practice Address - Street 2:NORTH BLDG STE B3
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3532
Practice Address - Country:US
Practice Address - Phone:505-604-5593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-06
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1114171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist