Healthcare Provider Details

I. General information

NPI: 1720179088
Provider Name (Legal Business Name): KRISTI L YACKLOVICH-MENICHESCHI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 RUSSELL DR
LEBANON PA
17042-7400
US

IV. Provider business mailing address

918 RUSSELL DR
LEBANON PA
17042-7400
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-7272
  • Fax: 717-272-0072
Mailing address:
  • Phone: 717-272-7272
  • Fax: 717-272-0072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP008929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: