MEDICARE: MRS. YVONNE GULINO FNP, CNM

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
1	363LF0000X	Family Nurse Practitioner	068100	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	068100	OTHER	MO	STATE RN LICENSE

General Provider Information

NPI Number	:	1235289125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. YVONNE GULINO FNP, CNM

Provider Business Mailing Address
First Line	:	22410 S COONCE LN
Second Line	:
City	:	HARTSBURG
State	:	MO
Zip	:	65039-9443
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1029 NICHOLS RD STE A
Second Line	:
City	:	OSAGE BEACH
State	:	MO
Zip	:	65065-3008
Country	:	US
Telephone Number	:	573-302-1604
Fax Number	:	573-302-1610

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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