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NPI Code Detail

MEDICARE: LENA MARIE YEATER

MEDICARE: LENA MARIE YEATER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant01375WV

General Provider Information

NPI Number : 1104868819
Entity Type Code : Individual
Provider Name (Legal Business Name) : LENA MARIE YEATER
Provider Business Mailing Address
First Line : 112 KUYKENDALL LN
Second Line :
City : MOOREFIELD
State : WV
Zip : 26836-1167
Country : US
Telephone Number : 304-530-7755
Fax Number : 304-530-7756
Provider Business Practice Location Address
First Line : 112 KUYKENDALL LN
Second Line :
City : MOOREFIELD
State : WV
Zip : 26836-1167
Country : US
Telephone Number : 304-530-7755
Fax Number : 304-530-7756
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 10/20/2010

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Directions to “ LENA MARIE YEATER ” Practice Location

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