Basic Information
Provider Information | |||||||||
NPI: | 1487654976 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | YATES | ||||||||
FirstName: | TANA | ||||||||
MiddleName: | H | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | CRNP-A | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | COPELAND | ||||||||
OtherFirstName: | TANA | ||||||||
OtherMiddleName: | H | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | CRNP-A | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 64294 | ||||||||
Address2: |   | ||||||||
City: | BALTIMORE | ||||||||
State: | MD | ||||||||
PostalCode: | 212644294 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4102806573 | ||||||||
FaxNumber: | 4102806515 | ||||||||
Practice Location | |||||||||
Address1: | 2002 MEDICAL PKWY | ||||||||
Address2: | SUITE 120 | ||||||||
City: | ANNAPOLIS | ||||||||
State: | MD | ||||||||
PostalCode: | 214013046 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4434815300 | ||||||||
FaxNumber: | 4434816705 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/26/2005 | ||||||||
LastUpdateDate: | 10/18/2007 | ||||||||
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 | 208600000X | R162103 | MD | Y |   | Allopathic & Osteopathic Physicians | Surgery |   |
ID Information
ID | Type | State | Issuer | Description | P00347745 | 01 | MD | RR MEDICARE | OTHER | 0006 | 01 | DC | CAREFIRST BCBS | OTHER | 64282101 | 01 | MD | CAREFIRST BCBS | OTHER |