Provider Demographics
NPI:1104578210
Name:HUILA-FLORES, YAQUELIN (RN)
Entity type:Individual
Prefix:
First Name:YAQUELIN
Middle Name:
Last Name:HUILA-FLORES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 W 10TH ST APT B103
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-1037
Mailing Address - Country:US
Mailing Address - Phone:541-993-7312
Mailing Address - Fax:
Practice Address - Street 1:1324 W 10TH ST APT B103
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-1037
Practice Address - Country:US
Practice Address - Phone:541-993-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201806534RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse