Provider Demographics
NPI:1902917826
Name:LARA, YOLANDA SAUCEDO (ARNP)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:SAUCEDO
Last Name:LARA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:LARA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1135 JADWIN AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-3434
Mailing Address - Country:US
Mailing Address - Phone:509-942-3300
Mailing Address - Fax:509-946-1868
Practice Address - Street 1:1135 JADWIN AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3434
Practice Address - Country:US
Practice Address - Phone:509-942-3300
Practice Address - Fax:509-946-1868
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0250110OtherLABOR & INDUSTRIES
WA9611013Medicaid
WA9611013Medicaid
WAS83752Medicare UPIN
WAAB10211Medicare ID - Type UnspecifiedMEDICARE NUMBER
WA9611013Medicaid