Provider Demographics
NPI:1073121042
Name:YACAVINO, MADELYN SUZANNE (NP-C)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:SUZANNE
Last Name:YACAVINO
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 1:11706 CLIFTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2018
Mailing Address - Country:US
Mailing Address - Phone:216-228-9296
Mailing Address - Fax:
Practice Address - Street 1:11706 CLIFTON BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-2018
Practice Address - Country:US
Practice Address - Phone:216-228-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0027116363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily