Healthcare Provider Details

I. General information

NPI: 1558560490
Provider Name (Legal Business Name): REBECCA LEIGH YUKICA D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 UPPER PLN
BRADFORD VT
05033-9207
US

IV. Provider business mailing address

331 UPPER PLN
BRADFORD VT
05033-9207
US

V. Phone/Fax

Practice location:
  • Phone: 802-222-4722
  • Fax: 802-222-4709
Mailing address:
  • Phone: 802-222-4722
  • Fax: 802-222-4709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0320000553
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: