Provider Demographics
NPI:1063678902
Name:YATVIN, LAURA BETH (RD CDE)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:BETH
Last Name:YATVIN
Suffix:
Gender:F
Credentials:RD CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6391 OVERBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2509
Mailing Address - Country:US
Mailing Address - Phone:215-477-4173
Mailing Address - Fax:215-546-5701
Practice Address - Street 1:6391 OVERBROOK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2509
Practice Address - Country:US
Practice Address - Phone:215-477-4173
Practice Address - Fax:215-546-5701
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN000706133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered