Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 65213 | ID |
NPI | 1043838634 |
---|---|
Provider Name | Mrs. Yendi Labelle |
First Address | Aurora, CO 80011-6405 |
Second Address | Coeur D'alene, ID 83814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2020 |
Last Update Date | 09/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0000000000000 | DO NOT HAVE (01) |