Provider Demographics
NPI:1255472312
Name:WYLLIE, YVONNE MAUREEN (RN)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:MAUREEN
Last Name:WYLLIE
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 1:2440 DONNA DR
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-7106
Mailing Address - Country:US
Mailing Address - Phone:707-445-1729
Mailing Address - Fax:
Practice Address - Street 1:2440 DONNA DR
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-7106
Practice Address - Country:US
Practice Address - Phone:707-445-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550824163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult