MEDICARE: D'ANDRE YORK FNP-C, PNP

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	95015175	CA

General Provider Information

NPI Number	:	1568077345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	D'ANDRE YORK FNP-C, PNP

Provider Business Mailing Address
First Line	:	241 RIVERWOOD DR
Second Line	:
City	:	BRAWLEY
State	:	CA
Zip	:	92227-1447
Country	:	US
Telephone Number	:	760-427-7798
Fax Number	:

Provider Business Practice Location Address
First Line	:	702 WAKE AVE
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-7502
Country	:	US
Telephone Number	:	760-352-7216
Fax Number	:

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

Provider Enumeration Date	:	09/09/2020
Last Update Date	:	09/09/2020

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