Healthcare Provider Details

I. General information

NPI: 1376269951
Provider Name (Legal Business Name): YANNETH AMARILES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 N HURSTBOURNE PKWY
LOUISVILLE KY
40241-2209
US

IV. Provider business mailing address

5202 IDLEWOOD LN
LOUISVILLE KY
40291-1462
US

V. Phone/Fax

Practice location:
  • Phone: 502-548-9684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SL0600X
TaxonomyLong-Term Care Clinical Nurse Specialist
License Number1138685
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: