Provider Demographics
NPI:1467018861
Name:YEATON, NICHOLE ANN (FNP)
Entity Type:Individual
Prefix:
First Name:NICHOLE
Middle Name:ANN
Last Name:YEATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STRONG
Mailing Address - State:ME
Mailing Address - Zip Code:04983-3005
Mailing Address - Country:US
Mailing Address - Phone:207-684-4010
Mailing Address - Fax:207-684-3368
Practice Address - Street 1:177 N MAIN ST
Practice Address - Street 2:
Practice Address - City:STRONG
Practice Address - State:ME
Practice Address - Zip Code:04983-3005
Practice Address - Country:US
Practice Address - Phone:207-684-4010
Practice Address - Fax:207-684-3368
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP191041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily