Healthcare Provider Details

I. General information

NPI: 1376034173
Provider Name (Legal Business Name): ANNDREA M YETTER MS, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 COMMONS AT KINGSWOOD DR
EAST BRUNSWICK NJ
08816-5230
US

IV. Provider business mailing address

3105 COMMONS AT KINGSWOOD DR
EAST BRUNSWICK NJ
08816-5230
US

V. Phone/Fax

Practice location:
  • Phone: 570-977-5774
  • Fax:
Mailing address:
  • Phone: 570-977-5774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number17459
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: