Healthcare Provider Details

I. General information

NPI: 1649770595
Provider Name (Legal Business Name): JOHN M YANKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2018
Last Update Date: 02/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3574
US

IV. Provider business mailing address

8449 WINDING TRL
LAUREL MD
20724-1435
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8118
  • Fax: 301-552-8118
Mailing address:
  • Phone: 301-455-8772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR187382
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: