Provider Demographics
NPI:1104182237
Name:YZENSKI, TERESA FAY (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:FAY
Last Name:YZENSKI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015
Mailing Address - Country:US
Mailing Address - Phone:229-273-1243
Mailing Address - Fax:229-273-1247
Practice Address - Street 1:412 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-273-1243
Practice Address - Fax:229-273-1247
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN102774367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003122631EMedicaid
GA003122631EMedicaid