Healthcare Provider Details

I. General information

NPI: 1528634011
Provider Name (Legal Business Name): MOLLY ELIZABETH YEAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

490 JEFFERS STREET
DUBOIS PA
15801
US

IV. Provider business mailing address

793 OLD ROUTE 119 HWY NORTH
INDIANA PA
15701
US

V. Phone/Fax

Practice location:
  • Phone: 814-371-1100
  • Fax:
Mailing address:
  • Phone: 724-465-5576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: