Provider Demographics
NPI:1922168293
Name:MCCALL, YVONNE M (PA)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:M
Last Name:MCCALL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:YVONNE
Other - Middle Name:MARIE
Other - Last Name:DRABEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1701 W. GARDEN STREET
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-3531
Mailing Address - Country:US
Mailing Address - Phone:309-680-7600
Mailing Address - Fax:309-676-5506
Practice Address - Street 1:1701 W. GARDEN STREET
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-3531
Practice Address - Country:US
Practice Address - Phone:309-680-7600
Practice Address - Fax:309-680-7637
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5160373-1206363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5160373-1206OtherSTATE LICENSE
UT5160373-8906OtherDOPL CONTROLLED SUBSTANCE
IL085-003423OtherSTATE LICENSE
UT1054008OtherNCCPA BOARD CERTIFICATION
UTPRA07224OtherMOLINA HEALTHCARE OF UT