Provider Demographics
NPI:1073843330
Name:TAITE, YOLANDA MARIE
Entity Type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:MARIE
Last Name:TAITE
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 1:304 SOUTHWEST BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36611-2113
Mailing Address - Country:US
Mailing Address - Phone:251-300-8526
Mailing Address - Fax:251-300-8531
Practice Address - Street 1:304 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36611-2113
Practice Address - Country:US
Practice Address - Phone:251-300-8526
Practice Address - Fax:251-300-8531
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-10
Last Update Date:2010-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171W00000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor