Healthcare Provider Details

I. General information

NPI: 1689803017
Provider Name (Legal Business Name): DESIREE A YETTER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2009
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 N MAIN ST STE 204
WASHINGTON PA
15301-4395
US

IV. Provider business mailing address

190 N MAIN ST STE 204
WASHINGTON PA
15301-4395
US

V. Phone/Fax

Practice location:
  • Phone: 724-225-9970
  • Fax: 724-223-4253
Mailing address:
  • Phone: 724-225-9970
  • Fax: 724-223-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS016162
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberOS016162
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: