Provider Demographics
NPI:1134331853
Name:YEANEY, MARY N (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:N
Last Name:YEANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 ARLINGTON BLVD.
Mailing Address - Street 2:STE 200
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042
Mailing Address - Country:US
Mailing Address - Phone:703-531-3627
Mailing Address - Fax:703-531-1591
Practice Address - Street 1:6565 ARLINGTON BLVD.
Practice Address - Street 2:STE 200
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042
Practice Address - Country:US
Practice Address - Phone:703-531-3627
Practice Address - Fax:703-531-1591
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN57476363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC028154200Medicaid
DC028154200Medicaid
004741C95Medicare ID - Type Unspecified