Healthcare Provider Details

I. General information

NPI: 1730258096
Provider Name (Legal Business Name): YVANE MARGARET WIMBERLY R.N.-N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 WINN WAY STE A210
DECATUR GA
30030-1712
US

IV. Provider business mailing address

497 WINN WAY STE A210
DECATUR GA
30030-1712
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-7033
  • Fax: 404-296-4661
Mailing address:
  • Phone: 404-294-7033
  • Fax: 404-296-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN137772
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: