1679685010 NPI number — MS. MARLENE YATES

Table of content: MS. MARLENE YATES (NPI 1679685010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679685010 NPI number — MS. MARLENE YATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YATES
Provider First Name:
MARLENE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
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:
1679685010
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:
4199 MASSILLON RD
Provider Second Line Business Mailing Address:
LOT 212
Provider Business Mailing Address City Name:
UNIONTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44685-8748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-896-0854
Provider Business Mailing Address Fax Number:
330-896-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4199 MASSILLON RD
Provider Second Line Business Practice Location Address:
LOT 212
Provider Business Practice Location Address City Name:
UNIONTOWN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44685-8748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-896-0854
Provider Business Practice Location Address Fax Number:
330-896-0854
Provider Enumeration Date:
08/31/2006

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: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2165204 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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