Healthcare Provider Details

I. General information

NPI: 1780548099
Provider Name (Legal Business Name): REBECCA ANN YETTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LOG CANOE CIR STE E
STEVENSVILLE MD
21666-2150
US

IV. Provider business mailing address

165 LOG CANOE CIR STE E
STEVENSVILLE MD
21666-2150
US

V. Phone/Fax

Practice location:
  • Phone: 410-643-1000
  • Fax:
Mailing address:
  • Phone: 410-643-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR247719
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: