Healthcare Provider Details

I. General information

NPI: 1760406227
Provider Name (Legal Business Name): MARY E YODER R.D.,C.N.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S LINCOLN AVE
LEBANON PA
17042-7529
US

IV. Provider business mailing address

1325 JUNIPER ST
LEBANON PA
17042-6439
US

V. Phone/Fax

Practice location:
  • Phone: 717-272-6621
  • Fax: 717-228-6078
Mailing address:
  • Phone: 717-272-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN001708
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: