MEDICARE: RYAN YETTER CNIM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZE0600X	Electroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number	:	1275801466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN YETTER CNIM

Provider Business Mailing Address
First Line	:	3027 E FREMONT ROAD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6009
Country	:	US
Telephone Number	:	714-309-7334
Fax Number	:

Provider Business Practice Location Address
First Line	:	3310 E FREMONT RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85042-6119
Country	:	US
Telephone Number	:	714-309-7334
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2011
Last Update Date	:	05/06/2022

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