Healthcare Provider Details

I. General information

NPI: 1659648913
Provider Name (Legal Business Name): MICHAELLA M YEUTTER RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2011
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 S HARBOR CITY BLVD SUITE A
MELBOURNE FL
32901-3242
US

IV. Provider business mailing address

PO BOX 866
MELBOURNE FL
32902-0866
US

V. Phone/Fax

Practice location:
  • Phone: 321-725-8919
  • Fax: 321-725-8854
Mailing address:
  • Phone: 321-725-8919
  • Fax: 321-725-8854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN3252742
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN3252742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: