Provider Demographics
NPI:1578501102
Name:YACONO-BRANDT, JOANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:YACONO-BRANDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HUSSON AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-3374
Mailing Address - Country:US
Mailing Address - Phone:207-941-2373
Mailing Address - Fax:207-941-8803
Practice Address - Street 1:302 HUSSON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-3374
Practice Address - Country:US
Practice Address - Phone:207-941-2373
Practice Address - Fax:207-941-8803
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-153363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME015225Medicare ID - Type Unspecified
MEPA153Medicare UPIN