Healthcare Provider Details

I. General information

NPI: 1245477215
Provider Name (Legal Business Name): YOLANDA M CARRASCO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2009
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKVILLE AVE APT 1L
OSSINING NY
10562-4500
US

IV. Provider business mailing address

1 BROOKVILLE AVE APT 1L
OSSINING NY
10562-4500
US

V. Phone/Fax

Practice location:
  • Phone: 914-432-8532
  • Fax:
Mailing address:
  • Phone: 914-432-8532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number466283-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: