Provider Demographics
NPI:1104381771
Name:YATES, VICTORIA (RN, HEALTH EDUCATOR)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:YATES
Suffix:
Gender:F
Credentials:RN, HEALTH EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 STATE ST STE OFFICE40
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-1716
Mailing Address - Country:US
Mailing Address - Phone:914-983-2825
Mailing Address - Fax:
Practice Address - Street 1:46 DEVOE ST
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-1844
Practice Address - Country:US
Practice Address - Phone:803-201-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator