Basic Information
Provider Information
NPI: 1275638124
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: YON
FirstName: YVONNE
MiddleName: CHRISTINE
NamePrefix: MRS.
NameSuffix:  
Credential: P.A.-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4500 STUART ST
Address2: MONCRIEF ARMY COMMUNITY HOSPITAL: ATTN: MCXL-PQ
City: COLUMBIA
State: SC
PostalCode: 292075700
CountryCode: US
TelephoneNumber: 8037512618
FaxNumber: 8037512689
Practice Location
Address1: 4500 STUART ST
Address2: MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
City: COLUMBIA
State: SC
PostalCode: 292075700
CountryCode: US
TelephoneNumber: 8037516218
FaxNumber: 8037512689
Other Information
ProviderEnumerationDate: 09/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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