Provider Demographics
NPI:1851628242
Name:YODER, SUSAN L (CRNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:YODER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 PENN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLSOPPLE
Mailing Address - State:PA
Mailing Address - Zip Code:15935-7310
Mailing Address - Country:US
Mailing Address - Phone:814-479-2257
Mailing Address - Fax:
Practice Address - Street 1:1063 PENN AVE
Practice Address - Street 2:
Practice Address - City:HOLLSOPPLE
Practice Address - State:PA
Practice Address - Zip Code:15935-7310
Practice Address - Country:US
Practice Address - Phone:814-479-2257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-06
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010548363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner