Healthcare Provider Details

I. General information

NPI: 1972547784
Provider Name (Legal Business Name): ANITA MARIE YEARLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 BRIDGEPORT WAY SW
LAKEWOOD WA
98499
US

IV. Provider business mailing address

505 S 336TH ST STE 600
FEDERAL WAY WA
98003-6328
US

V. Phone/Fax

Practice location:
  • Phone: 253-588-1711
  • Fax: 253-581-6588
Mailing address:
  • Phone: 253-838-6180
  • Fax: 253-838-6418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD00036471
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: