Provider Demographics
NPI:1194167718
Name:YONAKER, KELLY ANNE (RN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANNE
Last Name:YONAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ANNE
Other - Last Name:GARNHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:92 WEST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01887-3241
Mailing Address - Country:US
Mailing Address - Phone:978-988-2300
Mailing Address - Fax:978-988-2333
Practice Address - Street 1:92 WEST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:MA
Practice Address - Zip Code:01887-3241
Practice Address - Country:US
Practice Address - Phone:978-988-2300
Practice Address - Fax:978-988-2333
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2268952163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse