Healthcare Provider Details

I. General information

NPI: 1659208262
Provider Name (Legal Business Name): BLANCHE ETELLA YEATON BUSINESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 HILLCREST RD
ROCKLIN CA
95765-5068
US

IV. Provider business mailing address

2812 HILLCREST RD
ROCKLIN CA
95765-5068
US

V. Phone/Fax

Practice location:
  • Phone: 916-524-4966
  • Fax:
Mailing address:
  • Phone: 916-524-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number122342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: