1073504718 NPI number — MR. EDWARD EUGENE YACKEL MSN,APRN-BC (FNP)

Table of content: MR. EDWARD EUGENE YACKEL MSN,APRN-BC (FNP) (NPI 1073504718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073504718 NPI number — MR. EDWARD EUGENE YACKEL MSN,APRN-BC (FNP)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YACKEL
Provider First Name:
EDWARD
Provider Middle Name:
EUGENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSN,APRN-BC (FNP)
Provider Gender Code:
M

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:
1073504718
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
576 JEFFERSON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT EUSTIS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23604-1373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-314-7527
Provider Business Mailing Address Fax Number:
757-314-7661

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
576 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT EUSTIS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23604-1373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-314-7527
Provider Business Practice Location Address Fax Number:
757-314-7661
Provider Enumeration Date:
11/02/2005

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: 363LF0000X , with the licence number:  4704174725 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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