Provider Demographics
NPI:1134325020
Name:YUTANI, LYNELLE TOMIKO (RPA, RA, RT, CNMT)
Entity Type:Individual
Prefix:MS
First Name:LYNELLE
Middle Name:TOMIKO
Last Name:YUTANI
Suffix:
Gender:F
Credentials:RPA, RA, RT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1357
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:WY
Mailing Address - Zip Code:82633-1357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:675 10TH AVE W
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:BC
Practice Address - Zip Code:V5Z 1L3
Practice Address - Country:CA
Practice Address - Phone:604-877-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYGN0835-99246Z00000X, 247100000X, 2471C3401X, 2471C3402X, 2471N0900X
WYGN- 835-99243U00000X
2471M2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology
No2471M2300XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMammography