Healthcare Provider Details

I. General information

NPI: 1235597048
Provider Name (Legal Business Name): MARK YODER FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 CLEVELAND RD
WOOSTER OH
44691-2203
US

IV. Provider business mailing address

4724 BRAXTON LN
WOOSTER OH
44691-7602
US

V. Phone/Fax

Practice location:
  • Phone: 330-262-2500
  • Fax:
Mailing address:
  • Phone: 330-317-3852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.18740
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.18740-NP
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: