Provider Demographics
NPI:1114650546
Name:GOMES, YASSARA V (RN)
Entity Type:Individual
Prefix:
First Name:YASSARA
Middle Name:V
Last Name:GOMES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ALGONQUIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2452
Mailing Address - Country:US
Mailing Address - Phone:401-215-8402
Mailing Address - Fax:
Practice Address - Street 1:121 ALGONQUIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2452
Practice Address - Country:US
Practice Address - Phone:401-215-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2308343163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory CareGroup - Single Specialty