Provider Demographics
NPI:1548836158
Name:YOHANNAN, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:YOHANNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 CIRCLE BROOK DR APT E
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8253
Mailing Address - Country:US
Mailing Address - Phone:703-969-8633
Mailing Address - Fax:
Practice Address - Street 1:3323 CIRCLE BROOK DR APT E
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-8253
Practice Address - Country:US
Practice Address - Phone:703-969-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant