1609885672 NPI number — SUZANNE A YARAS CRNA

Table of content: SUZANNE A YARAS CRNA (NPI 1609885672)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609885672 NPI number — SUZANNE A YARAS CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YARAS
Provider First Name:
SUZANNE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609885672
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13523 BARRETT PARDWAY DRIVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63021-3802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-938-6868
Provider Business Mailing Address Fax Number:
636-938-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 PROFESSIONAL COURT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-420-5559
Provider Business Practice Location Address Fax Number:
240-420-3786
Provider Enumeration Date:
08/07/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  R100077 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)