Provider Demographics
NPI:1376651141
Name:YETTER, LESLIE S (RNCS PMH NP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:S
Last Name:YETTER
Suffix:
Gender:F
Credentials:RNCS PMH NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MEDICAL CENTER DR
Mailing Address - Street 2:MIDCOAST HOSPITAL
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-373-6086
Mailing Address - Fax:207-373-6080
Practice Address - Street 1:123 MEDICAL CENTER DR
Practice Address - Street 2:MIDCOAST HOSPITAL
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-373-6086
Practice Address - Fax:207-373-6080
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER035730363LP0808X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Not Answered364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P43393Medicare UPIN
MEN58057Medicare ID - Type Unspecified