1770591059 NPI number — MRS. JILL ANNETTE YARBROUGH LMT RM

Table of content: MRS. JILL ANNETTE YARBROUGH LMT RM (NPI 1770591059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770591059 NPI number — MRS. JILL ANNETTE YARBROUGH LMT RM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YARBROUGH
Provider First Name:
JILL
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT RM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCASLAND
Provider Other First Name:
JILL
Provider Other Middle Name:
ANNETTE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770591059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
808 SOUTH MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUNICE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-394-1466
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
808 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUNICE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-394-1466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/03/2006

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: 225700000X , with the licence number:  # 2383 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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