Provider Demographics
NPI:1487917647
Name:MERCADO, YVONNE YVETTE (RN,PHN)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:YVETTE
Last Name:MERCADO
Suffix:
Gender:F
Credentials:RN,PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14215 ROAD 28
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-5729
Mailing Address - Country:US
Mailing Address - Phone:559-675-7893
Mailing Address - Fax:559-674-7262
Practice Address - Street 1:14215 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-5729
Practice Address - Country:US
Practice Address - Phone:559-675-7893
Practice Address - Fax:559-674-7262
Is Sole Proprietor?:No
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646889163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health