Healthcare Provider Details

I. General information

NPI: 1639457187
Provider Name (Legal Business Name): TONI NICOLE YONISH PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONI NICOLE BOYER

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 04/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

IV. Provider business mailing address

1086 FRANKLIN ST
JOHNSTOWN PA
15905-4305
US

V. Phone/Fax

Practice location:
  • Phone: 814-534-9794
  • Fax: 814-534-3479
Mailing address:
  • Phone: 814-534-9794
  • Fax: 814-534-3479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberN.D.055990L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA054930
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA054930
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: