Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | A70762 | CA |
Y | 207V00000X | Obstetrician & Gynecologist | MD181252 | OR |
NPI | 1013989474 |
---|---|
Provider Name | Yvonne Marie Sculley |
First Address | Keesler Afb, MS 39534-2508 |
Second Address | Keesler Afb, MS 39534-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 22/09/2021 |