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NPI Code Detail

MEDICARE: MRS. LAURA CAMILLE YOKUM RD

MEDICARE: MRS. LAURA CAMILLE YOKUM RD
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
1133V00000XRegistered Dietitian30WV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WV LICENSE NO . 30OTHERWVSTATE LICENSE
2R580231OTHERWVNATIONAL ADA REGISTRATION

General Provider Information

NPI Number : 1679574305
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LAURA CAMILLE YOKUM RD
Provider Business Mailing Address
First Line : HC 59 BOX 4
Second Line :
City : SENECA ROCKS
State : WV
Zip : 26884-9526
Country : US
Telephone Number : 304-567-2488
Fax Number :
Provider Business Practice Location Address
First Line : 24 N MAIN ST
Second Line :
City : PETERSBURG
State : WV
Zip : 26847-1518
Country : US
Telephone Number : 304-257-1044
Fax Number : 304-257-2681
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/03/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. LAURA CAMILLE YOKUM RD” Practice Location

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