Healthcare Provider Details

I. General information

NPI: 1982947446
Provider Name (Legal Business Name): MELISSA YETTER RN IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 04/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

192 N EASTON BELMONT PIKE
STROUDSBURG PA
18360-7077
US

IV. Provider business mailing address

192 N EASTON BELMONT PIKE
STROUDSBURG PA
18360-7077
US

V. Phone/Fax

Practice location:
  • Phone: 570-629-6433
  • Fax:
Mailing address:
  • Phone: 570-629-6433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN201709L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number11133208
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: