Provider Demographics
NPI:1649062423
Name:REDVINE, YOLANDA S
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:S
Last Name:REDVINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 OAK AVE SW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-6569
Mailing Address - Country:US
Mailing Address - Phone:929-292-0464
Mailing Address - Fax:
Practice Address - Street 1:115 OAK AVE SW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6569
Practice Address - Country:US
Practice Address - Phone:929-292-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-19
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health