Provider Demographics
NPI:1891554846
Name:YANCEY, OCTAVIA GENISE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:OCTAVIA
Middle Name:GENISE
Last Name:YANCEY
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 1:4511 DR BEANS LEGACY CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-6385
Mailing Address - Country:US
Mailing Address - Phone:240-593-1195
Mailing Address - Fax:
Practice Address - Street 1:6915 LAUREL BOWIE RD STE 101
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1715
Practice Address - Country:US
Practice Address - Phone:301-262-1087
Practice Address - Fax:240-436-2850
Is Sole Proprietor?:No
Enumeration Date:2024-03-13
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194184163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical