1376586362 NPI number — HEIDI O'DAY YEE N.P.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376586362 NPI number — HEIDI O'DAY YEE N.P.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

YEE

Provider First Name:

HEIDI

Provider Middle Name:

O'DAY

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

N.P.

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

SHULTS

Provider Other First Name:

HEIDI

Provider Other Middle Name:

O'DAY

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

NP

Provider Other Last Name Type Code:

1

NPI Number:

1376586362

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

09/19/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2160 COLONIAL BLVD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT MYERS

Provider Business Mailing Address State Name:

FL

Provider Business Mailing Address Postal Code:

33907-1410

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

239-931-7342

Provider Business Mailing Address Fax Number:

239-931-7385

Provider First Line Business Practice Location Address:

1316 NELSON AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MODESTO

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

95350

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

209-575-5870

Provider Business Practice Location Address Fax Number:

209-575-5872

Provider Enumeration Date:

06/14/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 363L00000X , with the licence number:  17314-5 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 363LF0000X , with the licence number: 95002267 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 133250 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 2444478 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 36005800 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 4309500 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
• Identifier: 806T5SH . This is a "BCBS MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 207930500 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: HP69349 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: P00406072 . This is a "RR MEDICARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1047805 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 01-24253 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: B189 . This is a "CHAMPUS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".