Provider Demographics
NPI:1710955836
Name:FOX, YOLANDA B (APRN, CRNA)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:B
Last Name:FOX
Suffix:
Gender:F
Credentials:APRN, CRNA
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:B
Other - Last Name:JASENCZUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CRNA
Mailing Address - Street 1:111 FOUNDERS PLZ
Mailing Address - Street 2:#300 C/O IPMS
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-3212
Mailing Address - Country:US
Mailing Address - Phone:860-282-4137
Mailing Address - Fax:860-282-0170
Practice Address - Street 1:111 FOUNDERS PLZ
Practice Address - Street 2:#300 C/O IPMS
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3212
Practice Address - Country:US
Practice Address - Phone:860-282-4137
Practice Address - Fax:860-282-0170
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003028367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004242468Medicaid
CT004242468Medicaid