Healthcare Provider Details
I. General information
NPI: 1518488204
Provider Name (Legal Business Name): VIOLETA DIANA YEAGER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 07/03/2017
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:
III. Provider practice location address
950 E BOGARD RD STE 103
WASILLA AK
99654-7184
US
IV. Provider business mailing address
950 E BOGARD RD STE 103
WASILLA AK
99654-7184
US
V. Phone/Fax
- Phone: 907-352-2880
- Fax: 907-352-2885
- Phone: 907-352-2880
- Fax: 907-352-2885
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 163WE0003X |
| Taxonomy | Emergency Registered Nurse |
| License Number | RN76177 |
| License Number State | NV |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363LF0000X |
| Taxonomy | Family Nurse Practitioner |
| License Number | APRN002574 |
| License Number State | NV |
| # 3 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | APRN002574 |
| License Number State | NV |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: