Healthcare Provider Details

I. General information

NPI: 1528891314
Provider Name (Legal Business Name): CAROLINE ELIZABETH YEAKLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 TOWERS CRESCENT DR FL 5
VIENNA VA
22182-2710
US

IV. Provider business mailing address

10 K ST SE APT 1114
WASHINGTON DC
20003-0889
US

V. Phone/Fax

Practice location:
  • Phone: 571-789-2100
  • Fax:
Mailing address:
  • Phone: 443-604-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024191061
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: