Provider Demographics
NPI:1508296682
Name:MYERS, YVONNE
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:
Last Name:MYERS
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 1:4961 RICE LAKE RD
Mailing Address - Street 2:#105
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-8438
Mailing Address - Country:US
Mailing Address - Phone:218-727-0296
Mailing Address - Fax:218-740-3378
Practice Address - Street 1:4961 RICE LAKE RD
Practice Address - Street 2:#105
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-8438
Practice Address - Country:US
Practice Address - Phone:218-727-0296
Practice Address - Fax:218-740-3378
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR108453-3163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health