Provider Demographics
NPI:1427693647
Name:YONGKUMA, MEREDITH HARDY (RN)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:HARDY
Last Name:YONGKUMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205B CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-3701
Mailing Address - Country:US
Mailing Address - Phone:334-208-8710
Mailing Address - Fax:
Practice Address - Street 1:205B CHURCH ST
Practice Address - Street 2:
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-3701
Practice Address - Country:US
Practice Address - Phone:334-208-8710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106089163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse