Provider Demographics
NPI:1376941658
Name:YACHMETZ, BEVERLY
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:YACHMETZ
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 1:107 COMMERCIAL ST
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6507
Mailing Address - Country:US
Mailing Address - Phone:508-477-7090
Mailing Address - Fax:508-477-7028
Practice Address - Street 1:107 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6507
Practice Address - Country:US
Practice Address - Phone:508-477-7090
Practice Address - Fax:508-477-7028
Is Sole Proprietor?:No
Enumeration Date:2014-12-18
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH25329133NN1002X
MA09018459163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education