Healthcare Provider Details

I. General information

NPI: 1326970039
Provider Name (Legal Business Name): NICHOLAS YONDOLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 E OSBORN RD APT 415
PHOENIX AZ
85016-7077
US

IV. Provider business mailing address

1435 ROLLING ACRES RD
LATROBE PA
15650-4714
US

V. Phone/Fax

Practice location:
  • Phone: 724-205-5578
  • Fax:
Mailing address:
  • Phone: 724-205-5578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number339807
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: