Provider Demographics
NPI:1194507301
Name:BRISTOW, YVONNE THERESA (RN/GNP)
Entity type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:THERESA
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:RN/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ROBERTS ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5042
Mailing Address - Country:US
Mailing Address - Phone:516-293-0051
Mailing Address - Fax:516-293-0054
Practice Address - Street 1:41 BIRCH LN
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA PARK
Practice Address - State:NY
Practice Address - Zip Code:11762-3910
Practice Address - Country:US
Practice Address - Phone:516-308-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251802-01163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice