Healthcare Provider Details

I. General information

NPI: 1144294083
Provider Name (Legal Business Name): STEVEN THOMAS YADEN RN, MN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 804, BOX 6
FPO AE
09409
US

IV. Provider business mailing address

PSC 804, BOX 143
FPO AE
09409
US

V. Phone/Fax

Practice location:
  • Phone: 0114401637853568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN0014682
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: