Healthcare Provider Details

I. General information

NPI: 1871704064
Provider Name (Legal Business Name): YOLANDA RENEE ARTIS RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE # 1243
BROOKLYN NY
11203-2056
US

IV. Provider business mailing address

450 CLARKSON AVE # 1243
BROOKLYN NY
11203-2056
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-8289
  • Fax:
Mailing address:
  • Phone: 718-270-8289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number009198
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: