Provider Demographics
NPI:1750081485
Name:BLANC, YVETTE (FNP)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:BLANC
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:YVETTE
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:412 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:SILT
Mailing Address - State:CO
Mailing Address - Zip Code:81652-9785
Mailing Address - Country:US
Mailing Address - Phone:970-274-2368
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-2941
Practice Address - Country:US
Practice Address - Phone:970-625-0842
Practice Address - Fax:970-625-3706
Is Sole Proprietor?:No
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998107-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily