MEDICARE: YANIQUE L MAIS APRN/CNM

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	367A00000X	Advanced Practice Midwife	APRN11032279	FL

General Provider Information

NPI Number	:	1619584315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIQUE L MAIS APRN/CNM

Provider Business Mailing Address
First Line	:	3621 1/2 S DIXIE HWY
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33405-2227
Country	:	US
Telephone Number	:	754-226-7814
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 1/2 S DIXIE HWY
Second Line	:
City	:	WEST PALM BCH
State	:	FL
Zip	:	33405-2227
Country	:	US
Telephone Number	:	754-226-7814
Fax Number	:

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

Provider Enumeration Date	:	09/26/2020
Last Update Date	:	06/19/2024

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