Individual
KAORU YAMANOUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
800 WHITLEY ST, MOBILE, AL 36610-3318
(251) 456-2276
(251) 456-2205
Mailing address
PO BOX 2867, MOBILE, AL 36652-2867
(251) 690-8894
(251) 544-2188
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
1-100606
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP NUMBER
AL
01
—
1063439065
NPI SITE GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
Enumeration date
09/13/2010
Last updated
09/13/2010
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