Provider Demographics
NPI:1871822528
Name:FAIR, YOLONDA S (LPN)
Entity Type:Individual
Prefix:
First Name:YOLONDA
Middle Name:S
Last Name:FAIR
Suffix:
Gender:F
Credentials:LPN
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 67589
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-7589
Mailing Address - Country:US
Mailing Address - Phone:585-615-5937
Mailing Address - Fax:
Practice Address - Street 1:8 PATRIOTS LNDG
Practice Address - Street 2:APT A
Practice Address - City:GREECE
Practice Address - State:NY
Practice Address - Zip Code:14626-3935
Practice Address - Country:US
Practice Address - Phone:585-615-5937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298366164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse