MEDICARE: MS. KELLY ANNE YONAKER RN

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	RN2268952	MA

General Provider Information

NPI Number	:	1194167718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KELLY ANNE YONAKER RN

Provider Business Mailing Address
First Line	:	92 WEST ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-3241
Country	:	US
Telephone Number	:	978-988-2300
Fax Number	:	978-988-2333

Provider Business Practice Location Address
First Line	:	92 WEST ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-3241
Country	:	US
Telephone Number	:	978-988-2300
Fax Number	:	978-988-2333

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

Provider Enumeration Date	:	07/24/2013
Last Update Date	:	06/18/2014

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