Healthcare Provider Details

I. General information

NPI: 1891097861
Provider Name (Legal Business Name): ELISABETH WENDY YEUN MS, RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2010
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

IV. Provider business mailing address

510 BUTLER AVE
MARTINSBURG WV
25405-9990
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-0811
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDO2164
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: