Provider Demographics
NPI:1659095305
Name:FORTENBERRY, YUNDIA RENEE
Entity Type:Individual
Prefix:
First Name:YUNDIA
Middle Name:RENEE
Last Name:FORTENBERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8326 183RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:WA
Mailing Address - Zip Code:98579-9257
Mailing Address - Country:US
Mailing Address - Phone:208-651-4841
Mailing Address - Fax:
Practice Address - Street 1:8326 183RD AVE SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:WA
Practice Address - Zip Code:98579-9257
Practice Address - Country:US
Practice Address - Phone:208-651-4841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider