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NPI Code Detail

MEDICARE: MRS. KRISTA LYNNE YEZBACK BC-FNP

MEDICARE: MRS. KRISTA LYNNE YEZBACK BC-FNP
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 Practitioner4704189915MI

General Provider Information

NPI Number : 1851388854
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTA LYNNE YEZBACK BC-FNP
Provider Business Mailing Address
First Line : 3621 S STATE ST
Second Line : 700 KMS PLACE
City : ANN ARBOR
State : MI
Zip : 48108-1633
Country : US
Telephone Number : 734-936-2047
Fax Number :
Provider Business Practice Location Address
First Line : 1051 N CANTON CENTER RD
Second Line :
City : CANTON
State : MI
Zip : 48187-5097
Country : US
Telephone Number : 734-884-5400
Fax Number : 734-844-5298
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/04/2005
Last Update Date : 02/14/2013

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