Healthcare Provider Details

I. General information

NPI: 1215602990
Provider Name (Legal Business Name): ANGEL YAUCHZEE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 FALLOWATER LN STE E
ROANOKE VA
24018-0949
US

IV. Provider business mailing address

PO BOX 639295 DEPT 93394
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 540-315-1668
  • Fax:
Mailing address:
  • Phone: 248-266-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180402
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: