Healthcare Provider Details

I. General information

NPI: 1134641285
Provider Name (Legal Business Name): YOLANDA FONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 6TH ST STE 300
BREMERTON WA
98337-1866
US

IV. Provider business mailing address

345 6TH ST STE 300
BREMERTON WA
98337-1866
US

V. Phone/Fax

Practice location:
  • Phone: 360-728-2235
  • Fax: 360-813-1382
Mailing address:
  • Phone: 360-728-2235
  • Fax: 360-813-1382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00155720
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: