Provider Demographics
NPI:1710502687
Name:YAMAMORI, JOELLEN (LPN)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:
Last Name:YAMAMORI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26058 MOORESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ELKMONT
Mailing Address - State:AL
Mailing Address - Zip Code:35620-3571
Mailing Address - Country:US
Mailing Address - Phone:256-489-4370
Mailing Address - Fax:
Practice Address - Street 1:26058 MOORESVILLE RD
Practice Address - Street 2:
Practice Address - City:ELKMONT
Practice Address - State:AL
Practice Address - Zip Code:35620-3571
Practice Address - Country:US
Practice Address - Phone:256-489-4370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-071269164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2-071269OtherLICENSURE