Healthcare Provider Details

I. General information

NPI: 1326498304
Provider Name (Legal Business Name): SHARON KAY YAHNKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 OHIO ST # 604
SIDNEY IA
51652-8057
US

IV. Provider business mailing address

709 OHIO ST # 604
SIDNEY IA
51652-8057
US

V. Phone/Fax

Practice location:
  • Phone: 712-374-2093
  • Fax: 712-374-2093
Mailing address:
  • Phone: 712-374-2093
  • Fax: 712-374-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number165AC6540
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: