Healthcare Provider Details

I. General information

NPI: 1902290976
Provider Name (Legal Business Name): CAROLITA BELLE HERITAGE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLITA BELLE YODER

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 WHITE BEAR AVE N
MAPLEWOOD MN
55109-5110
US

IV. Provider business mailing address

2603 WHITE BEAR AVE N
MAPLEWOOD MN
55109-5110
US

V. Phone/Fax

Practice location:
  • Phone: 651-600-3035
  • Fax: 651-348-8783
Mailing address:
  • Phone: 651-600-3035
  • Fax: 651-348-8783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25540
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: