Provider Demographics
NPI:1548807589
Name:YOAKAM, ELLEN JANE (REGISTERED NNURSE)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:JANE
Last Name:YOAKAM
Suffix:
Gender:F
Credentials:REGISTERED NNURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:OH
Mailing Address - Zip Code:43080-0026
Mailing Address - Country:US
Mailing Address - Phone:740-398-6255
Mailing Address - Fax:
Practice Address - Street 1:4348 JOHNSTOWN UTICA RD
Practice Address - Street 2:4348 JOHNSTOWN UTICA RD
Practice Address - City:UTICA
Practice Address - State:OH
Practice Address - Zip Code:43080
Practice Address - Country:US
Practice Address - Phone:740-398-6255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH345810163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology