Healthcare Provider Details

I. General information

NPI: 1649003906
Provider Name (Legal Business Name): YVONNE MARIE ARLINE HEFNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2024
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MARK WEST SPRINGS RD
SANTA ROSA CA
95403-1436
US

IV. Provider business mailing address

1400 TECHNOLOGY LN APT 1414
PETALUMA CA
94954-6905
US

V. Phone/Fax

Practice location:
  • Phone: 707-576-4000
  • Fax:
Mailing address:
  • Phone: 918-402-1301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95031280
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: