Provider Demographics
NPI:1740408848
Name:TOLENTINO, YVONNE (BSPT,CNA)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:TOLENTINO
Suffix:
Gender:F
Credentials:BSPT,CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ACES CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1175
Mailing Address - Country:US
Mailing Address - Phone:907-929-1499
Mailing Address - Fax:907-929-1178
Practice Address - Street 1:120 ACES CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1175
Practice Address - Country:US
Practice Address - Phone:907-929-1499
Practice Address - Fax:907-929-1178
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000221310400000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care