MEDICARE: MRS. MICHAELLA M YEUTTER RNFA

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	163W00000X	Registered Nurse	RN3252742	FL
2	163WR0006X	Registered Nurse First Assistant	RN3252742	FL

General Provider Information

NPI Number	:	1659648913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHAELLA M YEUTTER RNFA

Provider Business Mailing Address
First Line	:	PO BOX 866
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32902-0866
Country	:	US
Telephone Number	:	321-725-8919
Fax Number	:	321-725-8854

Provider Business Practice Location Address
First Line	:	1250 S HARBOR CITY BLVD
Second Line	:	SUITE A
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3242
Country	:	US
Telephone Number	:	321-725-8919
Fax Number	:	321-725-8854

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

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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