Provider Demographics
NPI:1275801466
Name:YETTER, RYAN (CNIM)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:YETTER
Suffix:
Gender:M
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3027 E FREMONT ROAD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-6009
Mailing Address - Country:US
Mailing Address - Phone:714-309-7334
Mailing Address - Fax:
Practice Address - Street 1:3310 E FREMONT RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-6119
Practice Address - Country:US
Practice Address - Phone:714-309-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic