Provider Demographics
NPI:1639753783
Name:MUTURI, YVONNE (NP)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MUTURI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 BROADWAY APT 435
Mailing Address - Street 2:
Mailing Address - City:SAUGUS
Mailing Address - State:MA
Mailing Address - Zip Code:01906-3575
Mailing Address - Country:US
Mailing Address - Phone:774-253-0634
Mailing Address - Fax:
Practice Address - Street 1:815 POLLARD RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-1438
Practice Address - Country:US
Practice Address - Phone:774-253-0634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2025-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2274105163WE0003X, 163WG0000X, 163WG0000X
CANP95019041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner