Healthcare Provider Details

I. General information

NPI: 1124992441
Provider Name (Legal Business Name): YEJEE BIAZO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 BEACON ST
FORT WAYNE IN
46805-4749
US

IV. Provider business mailing address

2817 WESTBROOK DR APT 209
FORT WAYNE IN
46805-2024
US

V. Phone/Fax

Practice location:
  • Phone: 951-742-1656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28259928
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: