Provider Demographics
NPI:1740560960
Name:PETERS, YEWANDE OLUKEMI (RN)
Entity Type:Individual
Prefix:MRS
First Name:YEWANDE
Middle Name:OLUKEMI
Last Name:PETERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 CEDAR LN
Mailing Address - Street 2:MEDFORD
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1172
Mailing Address - Country:US
Mailing Address - Phone:516-557-5483
Mailing Address - Fax:
Practice Address - Street 1:116 CEDAR LN
Practice Address - Street 2:MEDFORD
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763-1172
Practice Address - Country:US
Practice Address - Phone:516-557-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY547367-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse