Provider Demographics
NPI:1265777171
Name:YARD, ROSALYN R (LPN)
Entity type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:R
Last Name:YARD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 NOSTRAND AVE
Mailing Address - Street 2:2ND FLR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7181
Mailing Address - Country:US
Mailing Address - Phone:718-421-4224
Mailing Address - Fax:718-421-4774
Practice Address - Street 1:1809 NOSTRAND AVE
Practice Address - Street 2:2ND FLR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7181
Practice Address - Country:US
Practice Address - Phone:718-421-4224
Practice Address - Fax:718-421-4774
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY311884164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02386450Medicaid