Healthcare Provider Details

I. General information

NPI: 1356492771
Provider Name (Legal Business Name): YVETTE ALISE FAUST RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2007
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 HARRIS ST
EUREKA CA
95503-4806
US

IV. Provider business mailing address

6290 WESTRIDGE CT
EUREKA CA
95503-9201
US

V. Phone/Fax

Practice location:
  • Phone: 707-445-3443
  • Fax:
Mailing address:
  • Phone: 707-445-7348
  • Fax: 707-443-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN411242
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: