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NPI Code Detail

MEDICARE: ANDA YURISICH

MEDICARE: ANDA YURISICH
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
1103K00000XBehavior AnalystOR
2374J00000XDoula

General Provider Information

NPI Number : 1942795646
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDA YURISICH
Provider Business Mailing Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number : 765-343-6393
Fax Number :
Provider Business Practice Location Address
First Line : 5534 SAINT JOE RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46835-3328
Country : US
Telephone Number : 765-343-6393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2018
Last Update Date : 02/21/2023

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Directions to “ ANDA YURISICH ” Practice Location

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