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NPI Code Detail

MEDICARE: YAIRA MALDONADO

MEDICARE: YAIRA MALDONADO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerNCO-000001GA

General Provider Information

NPI Number : 1023616661
Entity Type Code : Individual
Provider Name (Legal Business Name) : YAIRA MALDONADO
Provider Business Mailing Address
First Line : 191 LEE ROAD 207
Second Line :
City : PHENIX CITY
State : AL
Zip : 36870-8240
Country : US
Telephone Number : 423-227-5768
Fax Number :
Provider Business Practice Location Address
First Line : 4328 ARMOUR RD
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-5204
Country : US
Telephone Number : 706-507-1213
Fax Number : 706-507-1217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/15/2020
Last Update Date : 04/01/2021

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