Provider Demographics
NPI:1578658084
Name:YODFAT, KENDRA A (CRNA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:A
Last Name:YODFAT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:A
Other - Last Name:YARNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:118 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:111 S FRONT STREET
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-782-5182
Practice Address - Fax:717-782-8520
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN518902L163W00000X, 367500000X
PA071131367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001595427OtherHIGHMARK BLUE SHIELD
PA085437Medicare PIN