Healthcare Provider Details

I. General information

NPI: 1518203488
Provider Name (Legal Business Name): RENEE S YEATER MS, ATC, EMTB, PES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2012
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2209 OLDE MEADOW CT
EAST PETERSBURG PA
17520-1023
US

IV. Provider business mailing address

2209 OLDE MEADOW CT
EAST PETERSBURG PA
17520-1023
US

V. Phone/Fax

Practice location:
  • Phone: 717-799-6561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number164776
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT004306
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: