Provider Demographics
NPI:1336632207
Name:YOCUM, MAGGIE ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MAGGIE
Middle Name:ROSE
Last Name:YOCUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MAGGIE
Other - Middle Name:ROSE
Other - Last Name:EHLERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1029 STONE FURROW PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-4555
Mailing Address - Country:US
Mailing Address - Phone:610-223-8716
Mailing Address - Fax:
Practice Address - Street 1:6500 CREEDMOOR RD
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3697
Practice Address - Country:US
Practice Address - Phone:919-825-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant