Healthcare Provider Details

I. General information

NPI: 1386584530
Provider Name (Legal Business Name): JACLYN DI YESO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 E DUPONT RD STE 105
FORT WAYNE IN
46825-0045
US

IV. Provider business mailing address

1041 TAUSSIG PL NE
WASHINGTON DC
20017-2132
US

V. Phone/Fax

Practice location:
  • Phone: 260-222-7401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: