MEDICARE: MRS. MARY TERESA YOST CRNP-FAMILY

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
1	363LF0000X	Family Nurse Practitioner	R069879	MD

General Provider Information

NPI Number	:	1831475771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY TERESA YOST CRNP-FAMILY

Provider Business Mailing Address
First Line	:	6210 FRONTIER CT
Second Line	:
City	:	ELDERSBURG
State	:	MD
Zip	:	21784-6639
Country	:	US
Telephone Number	:	443-309-5013
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 N CAROLINE ST
Second Line	:	JHOPC ROOM 5253
City	:	BALTIMORE
State	:	MD
Zip	:	21287-0882
Country	:	US
Telephone Number	:	410-955-5455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2011
Last Update Date	:	10/24/2011

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