Doctor Name: | MR. EDWARD EUGENE YACKEL |
NPI Number: | 1073504718 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MSN,APRN-BC (FNP) |
License Number: | 4704174725 |
Business Practice Address: | 576 Jefferson Ave Fort Eustis, VA - 236041373 |
Business Phone Number: | 7573147527 |
Business Fax Number: | 7573147661 |
Mailing Address: | 576 Jefferson Ave, FORT EUSTIS |
State: | VA |
Postal Code: | 236041373 |
Phone Number: | 7573147527 |
Fax Number: | 7573147661 |
NPI Enumeration Date: | 11/02/2005 |
NPI Last Update Date: | 06/07/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 4704174725 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |