Healthcare Provider Details

I. General information

NPI: 1912905332
Provider Name (Legal Business Name): DORIS A YODER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1569 STONEMILL DR
ELIZABETHTOWN PA
17022-9439
US

IV. Provider business mailing address

804 NEW HOLLAND AVE
LANCASTER PA
17602-2163
US

V. Phone/Fax

Practice location:
  • Phone: 888-769-3992
  • Fax: 888-769-3992
Mailing address:
  • Phone: 888-769-3992
  • Fax: 888-769-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberUP001377B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: