Healthcare Provider Details

I. General information

NPI: 1376859249
Provider Name (Legal Business Name): ELSA MARIE YEDINAK RN, CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2010
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24000 JACARANDA DR
TEHACHAPI CA
93561-6523
US

IV. Provider business mailing address

24000 JACARANDA DR
TEHACHAPI CA
93561-6523
US

V. Phone/Fax

Practice location:
  • Phone: 805-405-8429
  • Fax:
Mailing address:
  • Phone: 805-405-8429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number18803
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number646166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: