Healthcare Provider Details

I. General information

NPI: 1467044248
Provider Name (Legal Business Name): YAHWEH B YAHWEH REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 GREENBRIER TRL
MILTON WV
25541-1190
US

IV. Provider business mailing address

5312 MACCORKLE AVE SW STE 284
SOUTH CHARLESTON WV
25309-1012
US

V. Phone/Fax

Practice location:
  • Phone: 919-638-3694
  • Fax:
Mailing address:
  • Phone: 919-638-3694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number62717
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number62717
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number62717
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number62717
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number62717
License Number StateWV
# 6
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License Number62717
License Number StateWV
# 7
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License Number62717
License Number StateWV
# 8
Primary TaxonomyN
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number62717
License Number StateWV
# 9
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number62717
License Number StateWV
# 10
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number62717
License Number StateWV
# 11
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 12
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number62717
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: