Provider Demographics
NPI:1720673338
Name:IRVIN, YOLANDA (LVN)
Entity Type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:IRVIN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 ANVIL RANGE RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3253
Mailing Address - Country:US
Mailing Address - Phone:254-813-1865
Mailing Address - Fax:
Practice Address - Street 1:3800 ANVIL RANGE RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3253
Practice Address - Country:US
Practice Address - Phone:254-813-1865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX327085164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse