Provider Demographics
NPI:1619135068
Name:YODER, MARK DAVID (LPN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:YODER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AVONDALE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2684
Mailing Address - Country:US
Mailing Address - Phone:650-307-0959
Mailing Address - Fax:
Practice Address - Street 1:1 AVONDALE DR
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2684
Practice Address - Country:US
Practice Address - Phone:650-307-0959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-01
Last Update Date:2008-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN-258838374T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel