Provider Demographics
NPI:1720179088
Name:YACKLOVICH-MENICHESCHI, KRISTI L (CRNP)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:L
Last Name:YACKLOVICH-MENICHESCHI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 RUSSELL DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-7400
Mailing Address - Country:US
Mailing Address - Phone:717-272-7272
Mailing Address - Fax:717-272-0072
Practice Address - Street 1:918 RUSSELL DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-7400
Practice Address - Country:US
Practice Address - Phone:717-272-7272
Practice Address - Fax:717-272-0072
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008929363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ73220Medicare UPIN
PA104919EHYMedicare PIN