Basic Information
Provider Information | |||||||||
NPI: | 1245645977 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | LI | ||||||||
FirstName: | YANNA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 807 MARSHALL DR | ||||||||
Address2: |   | ||||||||
City: | CARLISLE | ||||||||
State: | PA | ||||||||
PostalCode: | 170131665 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9176051137 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 100 N HANOVER ST | ||||||||
Address2: |   | ||||||||
City: | CARLISLE | ||||||||
State: | PA | ||||||||
PostalCode: | 170132421 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7172186670 | ||||||||
FaxNumber: | 7172186671 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/20/2014 | ||||||||
LastUpdateDate: | 01/12/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN603297 | PA | N |   | Nursing Service Providers | Registered Nurse |   | 363LF0000X | SP013749 | PA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | 1029089300001 | 05 | PA |   | MEDICAID |