Provider Demographics
NPI:1821073610
Name:YAMATAKI, EILEEN (CRNA)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:YAMATAKI
Suffix:
Gender:F
Credentials:CRNA
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 70-1612
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45270
Mailing Address - Country:US
Mailing Address - Phone:859-341-7246
Mailing Address - Fax:859-341-7867
Practice Address - Street 1:311 STRAIGHT ST
Practice Address - Street 2:MILLENIUM ANESTHESIA LLC
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-1018
Practice Address - Country:US
Practice Address - Phone:859-341-7246
Practice Address - Fax:859-341-7867
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH128210163W00000X
OH030493367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74006347Medicaid
727951OtherBUCKEYE
OH0767693Medicaid
000000195092OtherANTHEM BLUE SHIELD
OHYA8205536Medicare ID - Type Unspecified