Healthcare Provider Details

I. General information

NPI: 1871166199
Provider Name (Legal Business Name): MARCY YARBOROUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2021
Last Update Date: 08/16/2026
Certification Date: 07/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 PARK AVE
SCHENECTADY NY
12304-1628
US

IV. Provider business mailing address

122 PARK AVE
SCHENECTADY NY
12304-1628
US

V. Phone/Fax

Practice location:
  • Phone: 518-346-2387
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number358411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: