Basic Information
| Provider Information | |||||||||
| NPI: | 1487699294 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YELLAND | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | VIVONA | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | VIVONA | ||||||||
| OtherFirstName: | GRACE | ||||||||
| OtherMiddleName: | CAROL | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 850 | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983620146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604578578 | ||||||||
| FaxNumber: | 3604574841 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 W 8TH ST | ||||||||
| Address2: | |||||||||
| City: | PORT ANGELES | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983625904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604578578 | ||||||||
| FaxNumber: | 3604574841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2006 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MD00029053 | WA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.