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General NPI Number Information
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NPI Number | 1396963005
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Entity Type | Individual
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Provider Name | IRA YEDLIN ARNP
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 05/27/2010
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Provider Practice Location Address
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Address Line | 1645 E ROOSEVELT ST
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City | PHOENIX
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State | AZ
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Zip | 85006-3638
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Country | US
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Telephone | 602-372-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 17712 25TH AVE NE
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City | LAKE FOREST PARK
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State | WA
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Zip | 98155-5211
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | TAP3666
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | TAP3666
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License Number State | AZ
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