Healthcare Provider Details

I. General information

NPI: 1669422945
Provider Name (Legal Business Name): DANIELLE M YEAGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

734 CHATEAU CIR
VACAVILLE CA
95687-7434
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-7525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number670089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: