Healthcare Provider Details

I. General information

NPI: 1174182935
Provider Name (Legal Business Name): MISS YANA BOHEYNA FELIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2019
Last Update Date: 06/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 ORLEANS ST
BALTIMORE MD
21287-0010
US

IV. Provider business mailing address

6714 BONNIE RIDGE DR APT 202
BALTIMORE MD
21209-2855
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5255
  • Fax:
Mailing address:
  • Phone: 203-962-5057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberR221808
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: