| Doctor Name: | WILDA MAY YATES |
| NPI Number: | 1326211236 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | AA134756E |
| Business Practice Address: | 62 N Union St Star, ID - 83669 |
| Business Phone Number: | 2082860346 |
| Business Fax Number: | |
| Mailing Address: | 62 N Union St, STAR |
| State: | ID |
| Postal Code: | 83669 |
| Phone Number: | 2082860346 |
| Fax Number: | |
| NPI Enumeration Date: | 04/11/2008 |
| NPI Last Update Date: | 04/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 172A00000X |
| License Number: | AA134756E |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Driver |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person employed to operate a motor vehicle as a carrier of persons or property. |