Healthcare Provider Details

I. General information

NPI: 1487639126
Provider Name (Legal Business Name): CARLA YVONNE YORBA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S 8TH ST
YAKIMA WA
98901-3020
US

IV. Provider business mailing address

PO BOX 2605
YAKIMA WA
98907-2605
US

V. Phone/Fax

Practice location:
  • Phone: 509-454-4143
  • Fax:
Mailing address:
  • Phone: 509-454-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP 11433
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61529076
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11433
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN403128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: