Healthcare Provider Details

I. General information

NPI: 1306152285
Provider Name (Legal Business Name): JUDY ANN YETZER CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16712 PEARL RD
STRONGSVILLE OH
44136-6049
US

IV. Provider business mailing address

2500 W STRUB RD 330
SANDUSKY OH
44870-5390
US

V. Phone/Fax

Practice location:
  • Phone: 440-238-0360
  • Fax: 440-238-8835
Mailing address:
  • Phone: 419-626-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA 11600 NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: