Provider Demographics
NPI:1770009789
Name:YOCOM, SUNNY RAE (PROFESSIONAL PAYEE)
Entity Type:Individual
Prefix:MRS
First Name:SUNNY RAE
Middle Name:
Last Name:YOCOM
Suffix:
Gender:F
Credentials:PROFESSIONAL PAYEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-0628
Mailing Address - Country:US
Mailing Address - Phone:406-548-5915
Mailing Address - Fax:
Practice Address - Street 1:915 W DICKERSON ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4330
Practice Address - Country:US
Practice Address - Phone:406-548-5915
Practice Address - Fax:406-587-5876
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist