Provider Demographics
NPI:1649830779
Name:YINEMAN, MONICA (IDC)
Entity type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:
Last Name:YINEMAN
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MARTINEZSANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IDC
Mailing Address - Street 1:9812 ENCHANTMENT AVE NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8822
Mailing Address - Country:US
Mailing Address - Phone:360-850-8506
Mailing Address - Fax:
Practice Address - Street 1:9812 ENCHANTMENT AVE NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8822
Practice Address - Country:US
Practice Address - Phone:360-850-8506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman