Provider Demographics
NPI:1750362463
Name:KLEMMER, YOLANDA EUGENIA (CNM)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:EUGENIA
Last Name:KLEMMER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:EUGENIA
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:1220 12TH ST SE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-3722
Mailing Address - Country:US
Mailing Address - Phone:202-715-6572
Mailing Address - Fax:202-544-2714
Practice Address - Street 1:4130 HUNT PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3565
Practice Address - Country:US
Practice Address - Phone:202-388-8160
Practice Address - Fax:202-399-5419
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000108A367A00000X
DCRN1018511367A00000X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200532070Medicaid
DC024905300Medicaid
DC091827OtherMEDICARE