MEDICARE: MRS. MARYELLEN FRITZ YAMAMOTO RN

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	390200000X	Student in an Organized Health Care Education/Training Program	RN9234376	FL

General Provider Information

NPI Number	:	1639212459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARYELLEN FRITZ YAMAMOTO RN

Provider Business Mailing Address
First Line	:	9460 SW 9TH TER
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34476-8709
Country	:	US
Telephone Number	:	352-629-0137
Fax Number	:	352-629-0137

Provider Business Practice Location Address
First Line	:	MARION COUNTY HEALTH DEPTARTMENT
Second Line	:	1801SE 32ND AVENUE
City	:	OCALA
State	:	FL
Zip	:	34478
Country	:	US
Telephone Number	:	352-629-0137
Fax Number	:	352-694-4824

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

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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