Provider Demographics
NPI:1376859249
Name:YEDINAK, ELSA MARIE (RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:ELSA
Middle Name:MARIE
Last Name:YEDINAK
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24000 JACARANDA DR
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93561-6523
Mailing Address - Country:US
Mailing Address - Phone:805-405-8429
Mailing Address - Fax:
Practice Address - Street 1:24000 JACARANDA DR
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-6523
Practice Address - Country:US
Practice Address - Phone:805-405-8429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-29
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18803363LP0200X
CA646166163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics