Provider Demographics
NPI:1114220431
Name:RAFTER, YVONNE M
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:M
Last Name:RAFTER
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:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:SMOCK
Mailing Address - State:PA
Mailing Address - Zip Code:15480-0286
Mailing Address - Country:US
Mailing Address - Phone:724-677-0375
Mailing Address - Fax:
Practice Address - Street 1:42 SECOND ST
Practice Address - Street 2:
Practice Address - City:SMOCK
Practice Address - State:PA
Practice Address - Zip Code:15480-0286
Practice Address - Country:US
Practice Address - Phone:724-677-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN561464367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered