Healthcare Provider Details

I. General information

NPI: 1043268287
Provider Name (Legal Business Name): MARK A. YODER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 OAK ST SE STE 4030
SALEM OR
97301-3984
US

IV. Provider business mailing address

875 OAK ST SE STE 4030
SALEM OR
97301-3984
US

V. Phone/Fax

Practice location:
  • Phone: 503-561-6444
  • Fax: 503-561-6440
Mailing address:
  • Phone: 503-561-6444
  • Fax: 503-561-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10055555
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number172032
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number172032
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: