Healthcare Provider Details

I. General information

NPI: 1760959431
Provider Name (Legal Business Name): JUDITH CHEPKEMBOI YEGO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 TOWNE CENTRE RD STE 203
SAGINAW MI
48604-2833
US

IV. Provider business mailing address

4701 TOWNE CENTRE RD STE 203
SAGINAW MI
48604-2833
US

V. Phone/Fax

Practice location:
  • Phone: 989-792-2792
  • Fax:
Mailing address:
  • Phone: 989-792-2792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704291012
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: