MEDICARE: MICHAELINE MARY YAFFE CRNP

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	363LG0600X	Gerontology Nurse Practitioner	R070246	MD

General Provider Information

NPI Number	:	1487627683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELINE MARY YAFFE CRNP

Provider Business Mailing Address
First Line	:	16109 MARKOE RD
Second Line	:
City	:	MONKTON
State	:	MD
Zip	:	21111-1716
Country	:	US
Telephone Number	:	443-253-6563
Fax Number	:

Provider Business Practice Location Address
First Line	:	16109 MARKOE RD
Second Line	:
City	:	MONKTON
State	:	MD
Zip	:	21111-1716
Country	:	US
Telephone Number	:	443-253-6563
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	07/08/2007

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