Healthcare Provider Details

I. General information

NPI: 1962461772
Provider Name (Legal Business Name): LUANNE DERSTINE YEAGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 SCHAEFFER RD HERITAGE FAMILY HEALTH, PC
NEWMANSTOWN PA
17073-7023
US

IV. Provider business mailing address

1297 SCHAEFFER RD HERITAGE FAMILY HEALTH, PC
NEWMANSTOWN PA
17073-7023
US

V. Phone/Fax

Practice location:
  • Phone: 717-949-4138
  • Fax: 717-949-4140
Mailing address:
  • Phone: 717-949-4138
  • Fax: 717-949-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD427632
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: