Provider Demographics
NPI:1477782605
Name:YATES, ALEXA BROOKE (STNA)
Entity Type:Individual
Prefix:MISS
First Name:ALEXA
Middle Name:BROOKE
Last Name:YATES
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:962 PIPER RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-1354
Mailing Address - Country:US
Mailing Address - Phone:419-632-0413
Mailing Address - Fax:
Practice Address - Street 1:962 PIPER RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44905-1354
Practice Address - Country:US
Practice Address - Phone:419-632-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-09
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400685551107376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide