Healthcare Provider Details

I. General information

NPI: 1891422416
Provider Name (Legal Business Name): DWAYNE YEE FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2022
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15230 LAKESHORE DR
CLEARLAKE CA
95422-8107
US

IV. Provider business mailing address

15230 LAKESHORE DR
CLEARLAKE CA
95422-8107
US

V. Phone/Fax

Practice location:
  • Phone: 707-995-4500
  • Fax:
Mailing address:
  • Phone: 707-995-4500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022112
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: