Provider Demographics
NPI:1245645977
Name:LI, YANNA (CRNP)
Entity type:Individual
Prefix:
First Name:YANNA
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 MARSHALL DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-1665
Mailing Address - Country:US
Mailing Address - Phone:917-605-1137
Mailing Address - Fax:
Practice Address - Street 1:100 N HANOVER ST
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2421
Practice Address - Country:US
Practice Address - Phone:717-218-6670
Practice Address - Fax:717-218-6671
Is Sole Proprietor?:No
Enumeration Date:2014-06-20
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN603297163W00000X
PASP013749363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1029089300001Medicaid