1639212459 NPI number — MRS. MARYELLEN FRITZ YAMAMOTO RN

Table of content: MRS. MARYELLEN FRITZ YAMAMOTO RN (NPI 1639212459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639212459 NPI number — MRS. MARYELLEN FRITZ YAMAMOTO RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAMAMOTO
Provider First Name:
MARYELLEN
Provider Middle Name:
FRITZ
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1639212459
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:
9460 SW 9TH TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34476-8709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-629-0137
Provider Business Mailing Address Fax Number:
352-629-0137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MARION COUNTY HEALTH DEPTARTMENT
Provider Second Line Business Practice Location Address:
1801SE 32ND AVENUE
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-629-0137
Provider Business Practice Location Address Fax Number:
352-694-4824
Provider Enumeration Date:
02/14/2007

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: 390200000X , with the licence number:  RN9234376 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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