Healthcare Provider Details

I. General information

NPI: 1023887015
Provider Name (Legal Business Name): VENITA I YETSKO CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/01/2024
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 23RD ST
CUYAHOGA FALLS OH
44223-1404
US

IV. Provider business mailing address

2422 COVENTRY DR
PARMA OH
44134-5752
US

V. Phone/Fax

Practice location:
  • Phone: 330-971-7246
  • Fax: 330-971-7256
Mailing address:
  • Phone: 440-554-1442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0035134
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: