Basic Information
Provider Information
NPI: 1124101001
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HELLAND
FirstName: YVONNE
MiddleName: JANET
NamePrefix:  
NameSuffix:  
Credential: RNC, MSN, NNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8109 KATHLEEN DR
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761376113
CountryCode: US
TelephoneNumber: 8173068093
FaxNumber:  
Practice Location
Address1: 1325 PENNSYLVANIA AVE
Address2:  
City: FORT WORTH
State: TX
PostalCode: 761042158
CountryCode: US
TelephoneNumber: 8172502892
FaxNumber: 8172505335
Other Information
ProviderEnumerationDate: 10/23/2006
LastUpdateDate: 06/19/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LN0000X558408TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal

No ID Information.


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