Healthcare Provider Details

I. General information

NPI: 1336659069
Provider Name (Legal Business Name): JENNIFER L YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2017
Last Update Date: 10/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E 2ND ST
DEFIANCE OH
43512-2440
US

IV. Provider business mailing address

1400 E 2ND ST
DEFIANCE OH
43512-2440
US

V. Phone/Fax

Practice location:
  • Phone: 419-784-1414
  • Fax:
Mailing address:
  • Phone: 419-784-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.021859
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: