Healthcare Provider Details

I. General information

NPI: 1891897112
Provider Name (Legal Business Name): CHARLOTTE H YEOMANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

IV. Provider business mailing address

3377 RIVERBEND DR
SPRINGFIELD OR
97477-8803
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-6389
  • Fax: 541-222-6385
Mailing address:
  • Phone: 541-222-6389
  • Fax: 541-222-6385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM-11319
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD184573
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number12611
License Number StateMT
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD184573
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD60034362
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: