Healthcare Provider Details

I. General information

NPI: 1871304774
Provider Name (Legal Business Name): RASHAHLA N YAZDANI PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 01/20/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

IV. Provider business mailing address

303 E KEARSLEY ST
FLINT MI
48502-1907
US

V. Phone/Fax

Practice location:
  • Phone: 810-762-3300
  • Fax:
Mailing address:
  • Phone: 810-762-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704358405
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: