Provider Demographics
NPI:1003418955
Name:YAZVEC, JODIE LYNN
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:LYNN
Last Name:YAZVEC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 MARKET ST NE
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:OH
Mailing Address - Zip Code:44662-8576
Mailing Address - Country:US
Mailing Address - Phone:330-844-4793
Mailing Address - Fax:
Practice Address - Street 1:1201 MARKET ST NE
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:OH
Practice Address - Zip Code:44662-8576
Practice Address - Country:US
Practice Address - Phone:330-844-4793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)