1508343856 NPI number — AMBER LEIGH YEOMANS MASTERS DEGREE IN ED

Table of content: AMBER LEIGH YEOMANS MASTERS DEGREE IN ED (NPI 1508343856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508343856 NPI number — AMBER LEIGH YEOMANS MASTERS DEGREE IN ED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEOMANS
Provider First Name:
AMBER
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MASTERS DEGREE IN ED
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:
1508343856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4459 47TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34120-1795
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-227-9015
Provider Business Mailing Address Fax Number:
239-227-9015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5432 RATTLESNAKE HAMMOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34113-7454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-316-7656
Provider Business Practice Location Address Fax Number:
239-331-2581
Provider Enumeration Date:
07/19/2018

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: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019828500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com