Doctor Name: | FAYE YETTON |
NPI Number: | 1003218116 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 209006898 |
Business Practice Address: | 2015 W Austin Dr Peoria, IL - 616143910 |
Business Phone Number: | 3092560632 |
Business Fax Number: | |
Mailing Address: | 2015 W Austin Dr, PEORIA |
State: | IL |
Postal Code: | 61614 |
Phone Number: | 3092560632 |
Fax Number: | |
NPI Enumeration Date: | 09/19/2014 |
NPI Last Update Date: | 09/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 364SE0003X |
License Number: | 209006898 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Clinical Nurse Specialist |
Taxonomy Specialization: | Emergency |
Taxonomy Definition: |