Provider Demographics
NPI:1407689508
Name:YARBROUGH, ANTIONETTE M
Entity type:Individual
Prefix:
First Name:ANTIONETTE
Middle Name:M
Last Name:YARBROUGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9542 TREYBURN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-6888
Mailing Address - Country:US
Mailing Address - Phone:404-447-0827
Mailing Address - Fax:
Practice Address - Street 1:9542 TREYBURN LAKES DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46239-6888
Practice Address - Country:US
Practice Address - Phone:404-447-0827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker