Provider Demographics
NPI:1801121298
Name:SEDANO, YOLANDA S (PA-C)
Entity type:Individual
Prefix:MRS
First Name:YOLANDA
Middle Name:S
Last Name:SEDANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:YOLANDA
Other - Middle Name:S
Other - Last Name:SEDANO DE GUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:132 5TH AVE WEST
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338
Mailing Address - Country:US
Mailing Address - Phone:208-324-5286
Mailing Address - Fax:208-324-9815
Practice Address - Street 1:132 5TH AVE WEST
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338
Practice Address - Country:US
Practice Address - Phone:208-324-5286
Practice Address - Fax:208-324-5286
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA902363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID10000704157OtherBS
ID808529900Medicaid
IDPA099OtherBC
ID16677371Medicare PIN