Provider Demographics
NPI:1376034173
Name:YETTER, ANNDREA M (MS, CNS)
Entity Type:Individual
Prefix:
First Name:ANNDREA
Middle Name:M
Last Name:YETTER
Suffix:
Gender:F
Credentials:MS, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 COMMONS AT KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5230
Mailing Address - Country:US
Mailing Address - Phone:570-977-5774
Mailing Address - Fax:
Practice Address - Street 1:3105 COMMONS AT KINGSWOOD DR
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5230
Practice Address - Country:US
Practice Address - Phone:570-977-5774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17459133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPL1744427OtherFLIP
NJ0646673878-8OtherHPSO