Healthcare Provider Details

I. General information

NPI: 1306536537
Provider Name (Legal Business Name): YVETTE MICHELLE FELDMAN RN, MSN, ACCNS-P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 W SIX SHOOTER ST
MIDDLETON ID
83644-6205
US

IV. Provider business mailing address

1332 W SIX SHOOTER ST
MIDDLETON ID
83644-6205
US

V. Phone/Fax

Practice location:
  • Phone: 916-397-2560
  • Fax:
Mailing address:
  • Phone: 916-397-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number4929
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number69838
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number540077
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number69838
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: