=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215989181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HARRIET L YURKOVICH A.R.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2006
-----------------------------------------------------
Last Update Date | 12/18/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 E. EASTLAND CENTER COURT # 200
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-478-9299
-----------------------------------------------------
Fax | 816-478-9299
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19000 E EASTLAND CENTER CT #200
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-7022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-478-9299
-----------------------------------------------------
Fax | 816-478-9299
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 2010020654
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------