Provider Demographics
NPI:1285300699
Name:MCKENNA, YVONNE (NP-C)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MCKENNA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 HARBORAGE WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-3538
Mailing Address - Country:US
Mailing Address - Phone:415-816-3988
Mailing Address - Fax:
Practice Address - Street 1:1428 18TH ST APT 9
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5132
Practice Address - Country:US
Practice Address - Phone:415-816-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily