Healthcare Provider Details

I. General information

NPI: 1992010045
Provider Name (Legal Business Name): PATRICIA LYNN YEAROUT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 PEACEKEEPER WAY BLDG 209
MCCLELLAN CA
95652
US

IV. Provider business mailing address

5644 RAFFERTY AVE
MCCLELLAN CA
95652
US

V. Phone/Fax

Practice location:
  • Phone: 916-830-1511
  • Fax:
Mailing address:
  • Phone: 916-830-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR853425
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: