Individual provider Active NPI

Ira Yedlin, ARNP

  • Advanced Practice Midwife
  • Phoenix, AZ
National Provider Identifier
1396963005
Registry record updated May 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
TAP3666 Issued in AZ
Practice address
1645 E Roosevelt St
Phoenix, AZ 85006-3638
Phone
(602) 372-1718
NPI assigned
Apr 20, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X TAP3666 AZ
Advanced Practice Midwife 367A00000X TAP3666 AZ Primary

Addresses

Primary practice location

1645 E Roosevelt St
Phoenix, AZ 85006-3638

Mailing address

17712 25TH Ave NE
Lake Forest Park, WA 98155-5211

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
TAP3666AZMDAdvanced Practice Midwife

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274918400000",
    "number": "1396963005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17712 25TH AVE NE",
            "city": "LAKE FOREST PARK",
            "state": "WA",
            "postal_code": "981555211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1645 E ROOSEVELT ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850063638",
            "telephone_number": "602-372-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YEDLIN",
        "first_name": "IRA",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2010-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "TAP3666",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "AZ",
            "license": "TAP3666",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.