Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 95002359 | CA |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | RN1057546 | DC |
NPI | 1033526900 |
---|---|
Provider Name | Jill Yastishak |
First Address | Atlanta, GA 30374-4785 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2014 |
Last Update Date | 08/10/2020 |