Healthcare Provider Details

I. General information

NPI: 1487009288
Provider Name (Legal Business Name): JACQUELINE YEAGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2016
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W 30TH ST
LOS ANGELES CA
90007-3320
US

IV. Provider business mailing address

35389 MARABELLA CT
WINCHESTER CA
92596-8478
US

V. Phone/Fax

Practice location:
  • Phone: 213-284-3200
  • Fax:
Mailing address:
  • Phone: 626-537-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: