Provider Demographics
NPI:1629674296
Name:MYERS, YVETTE LYN (LAC)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:LYN
Last Name:MYERS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WALDEN MILL WAY
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-2812
Mailing Address - Country:US
Mailing Address - Phone:443-956-9672
Mailing Address - Fax:
Practice Address - Street 1:57 WALDEN MILL WAY
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-2812
Practice Address - Country:US
Practice Address - Phone:443-956-9672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist