Provider Demographics
NPI:1730066838
Name:YODER, NICOLE ELAINE (CRNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:ELAINE
Last Name:YODER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELAINE
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11035 NATIONAL PIKE
Mailing Address - Street 2:
Mailing Address - City:GRANTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21536-2012
Mailing Address - Country:US
Mailing Address - Phone:301-616-8161
Mailing Address - Fax:
Practice Address - Street 1:104 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:GRANTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21536-1086
Practice Address - Country:US
Practice Address - Phone:301-895-5107
Practice Address - Fax:833-448-0359
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR225543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily