Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | AP61124296 | WA |
NPI | 1013515824 |
---|---|
Provider Name | Yazmin Yoshellin Cervantes |
First Address | University Place, WA 98467-1647 |
Second Address | Tacoma, WA 98405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2020 |
Last Update Date | 26/02/2021 |