Provider Demographics
NPI:1609658806
Name:VINES, YOLANDA FAYE (RN)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:FAYE
Last Name:VINES
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 1:420 TETON CIR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3388
Mailing Address - Country:US
Mailing Address - Phone:757-761-4030
Mailing Address - Fax:
Practice Address - Street 1:100 7TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4800
Practice Address - Country:US
Practice Address - Phone:757-761-4030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001255746163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health