Provider Demographics
NPI:1215989181
Name:YURKOVICH, HARRIET L (ARNP)
Entity type:Individual
Prefix:
First Name:HARRIET
Middle Name:L
Last Name:YURKOVICH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19000 E EASTLAND CENTER CT
Mailing Address - Street 2:#200
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-7022
Mailing Address - Country:US
Mailing Address - Phone:816-478-9299
Mailing Address - Fax:816-478-9299
Practice Address - Street 1:1900 E. EASTLAND CENTER COURT
Practice Address - Street 2:# 200
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055
Practice Address - Country:US
Practice Address - Phone:816-478-9299
Practice Address - Fax:816-478-9299
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020654363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
R08000011Medicare PIN