1104462894 NPI number — SHAUNNA MARIE YOKUM FNP-C

Table of content: SHAUNNA MARIE YOKUM FNP-C (NPI 1104462894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104462894 NPI number — SHAUNNA MARIE YOKUM FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOKUM
Provider First Name:
SHAUNNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
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:
1104462894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
260 GASTON MANOR RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JANE LEW
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26378-8027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-940-9451
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
921 MINERAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENVILLE
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26351-1342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-462-1020
Provider Business Practice Location Address Fax Number:
304-462-1021
Provider Enumeration Date:
11/18/2019

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:  104968 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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