Provider Demographics
NPI:1407003320
Name:PETERS, YVONNE RENEE (RN, BS, DCS)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:RENEE
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN, BS, DCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1547
Mailing Address - Country:US
Mailing Address - Phone:585-223-1393
Mailing Address - Fax:
Practice Address - Street 1:64 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1547
Practice Address - Country:US
Practice Address - Phone:585-223-1393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY446302-1163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator