MEDICARE: ETTA MARIA YANCEY FNP-C

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	363L00000X	Nurse Practitioner	221209	LA

General Provider Information

NPI Number	:	1306519517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ETTA MARIA YANCEY FNP-C

Provider Business Mailing Address
First Line	:	8742 GOODWOOD BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-7915
Country	:	US
Telephone Number	:	985-688-8970
Fax Number	:

Provider Business Practice Location Address
First Line	:	37488 SEVEN OAKS AVE
Second Line	:
City	:	PRAIRIEVILLE
State	:	LA
Zip	:	70769-4355
Country	:	US
Telephone Number	:	198-568-8897
Fax Number	:

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

Provider Enumeration Date	:	07/26/2021
Last Update Date	:	10/21/2021

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