MEDICARE: YOLANDA PENA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	572637-1	NY

General Provider Information

NPI Number	:	1114584646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YOLANDA PENA

Provider Business Mailing Address
First Line	:	3521 81ST ST APT 6A
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11372-5005
Country	:	US
Telephone Number	:	718-316-3066
Fax Number	:

Provider Business Practice Location Address
First Line	:	3521 81ST ST APT 6A
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11372-5005
Country	:	US
Telephone Number	:	718-316-3066
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2019
Last Update Date	:	05/20/2019

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Directions to “ YOLANDA PENA ” Practice Location

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