Individual
MS. SHIRLEY YANAVOK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501A S MAIN ST, PHILLIPSBURG, NJ 08865-3137
(908) 763-7358
Mailing address
501A S MAIN ST, PHILLIPSBURG, NJ 08865-3137
(908) 763-7358
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
Y03817087354725
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y03817087354725
DRIVER LICENSE
NJ
Enumeration date
06/21/2018
Last updated
06/21/2018
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