MEDICARE: HOLLIE A YODER FNP-BC

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	363LF0000X	Family Nurse Practitioner	209006666	IL

General Provider Information

NPI Number	:	1548476922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLIE A YODER FNP-BC

Provider Business Mailing Address
First Line	:	2122 TROY RD STE 130
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-2540
Country	:	US
Telephone Number	:	618-800-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 TROY RD STE 130
Second Line	:
City	:	EDWARDSVILLE
State	:	IL
Zip	:	62025-2540
Country	:	US
Telephone Number	:	618-800-4500
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	09/26/2025

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Directions to “ HOLLIE A YODER FNP-BC” Practice Location

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