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General NPI Number Information
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NPI Number | 1093367278
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Entity Type | Individual
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Provider Name | TRICIA RAE YATES
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Gender | Female
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 140 S RIVER RD
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City | WATERVILLE
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State | OH
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Zip | 43566-1467
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Country | US
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Telephone | 419-878-8513
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Fax |
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Provider Business Mailing Address
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Address Line | 6707 SANTO LN
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City | MAUMEE
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State | OH
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Zip | 43537-1250
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Country | US
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Telephone | 419-460-3244
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRNCNP025066
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License Number State | OH
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