Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1124067939 |
---|---|
Provider Name | Mr. Jonathan Edward Yanke |
First Address | Stevensville, MD 21666-2500 |
Second Address | Severna Park, MD 21146-4137 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2006 |
Last Update Date | 21/11/2016 |