MEDICARE: MS. EMMA C YONKERS

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	2255A2300X	Athletic Trainer

General Provider Information

NPI Number	:	1649738824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EMMA C YONKERS

Provider Business Mailing Address
First Line	:	4050 W PINE BLVD APT 3207
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3349
Country	:	US
Telephone Number	:	847-436-5331
Fax Number	:

Provider Business Practice Location Address
First Line	:	4050 W PINE BLVD APT 3207
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-3349
Country	:	US
Telephone Number	:	847-436-5331
Fax Number	:

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

Provider Enumeration Date	:	03/07/2019
Last Update Date	:	03/07/2019

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