MEDICARE: ANNDREA M YETTER MS, CNS

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	133N00000X	Nutritionist	17459	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PL1744427	OTHER	NJ	FLIP
2	0646673878-8	OTHER	NJ	HPSO

General Provider Information

NPI Number	:	1376034173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNDREA M YETTER MS, CNS

Provider Business Mailing Address
First Line	:	3105 COMMONS AT KINGSWOOD DR
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5230
Country	:	US
Telephone Number	:	570-977-5774
Fax Number	:

Provider Business Practice Location Address
First Line	:	3105 COMMONS AT KINGSWOOD DR
Second Line	:
City	:	EAST BRUNSWICK
State	:	NJ
Zip	:	08816-5230
Country	:	US
Telephone Number	:	570-977-5774
Fax Number	:

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

Provider Enumeration Date	:	05/29/2018
Last Update Date	:	05/29/2018

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