Provider Demographics
NPI:1033790456
Name:YERBY, ANDREA (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:YERBY
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 CLOUDCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:ORANGEVALE
Mailing Address - State:CA
Mailing Address - Zip Code:95662-3925
Mailing Address - Country:US
Mailing Address - Phone:916-385-7034
Mailing Address - Fax:916-989-2652
Practice Address - Street 1:8505 CLOUDCROFT WAY
Practice Address - Street 2:
Practice Address - City:ORANGEVALE
Practice Address - State:CA
Practice Address - Zip Code:95662-3925
Practice Address - Country:US
Practice Address - Phone:916-385-7034
Practice Address - Fax:916-989-2652
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342700486253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care