Provider Demographics
NPI:1639212459
Name:YAMAMOTO, MARYELLEN FRITZ (RN)
Entity Type:Individual
Prefix:MRS
First Name:MARYELLEN
Middle Name:FRITZ
Last Name:YAMAMOTO
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 1:9460 SW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-8709
Mailing Address - Country:US
Mailing Address - Phone:352-629-0137
Mailing Address - Fax:352-629-0137
Practice Address - Street 1:MARION COUNTY HEALTH DEPTARTMENT
Practice Address - Street 2:1801SE 32ND AVENUE
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34478
Practice Address - Country:US
Practice Address - Phone:352-629-0137
Practice Address - Fax:352-694-4824
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9234376390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program