Provider Demographics
NPI:1881737203
Name:YOCUM, ROSEMARY (LAC)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:YOCUM
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 ROSEMARY LOOP, #1
Mailing Address - Street 2:
Mailing Address - City:PRIEST LAKE
Mailing Address - State:ID
Mailing Address - Zip Code:83856-8689
Mailing Address - Country:US
Mailing Address - Phone:208-443-3171
Mailing Address - Fax:
Practice Address - Street 1:168 ROSEMARY LOOP, #1
Practice Address - Street 2:
Practice Address - City:PRIEST LAKE
Practice Address - State:ID
Practice Address - Zip Code:83856-8689
Practice Address - Country:US
Practice Address - Phone:208-443-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDACU-11171100000X
WAAC00000397171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist