Provider Demographics
NPI:1851990501
Name:YOST, MILDRED J
Entity Type:Individual
Prefix:
First Name:MILDRED
Middle Name:J
Last Name:YOST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 RIDGEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MILAN
Mailing Address - State:OH
Mailing Address - Zip Code:44846-9530
Mailing Address - Country:US
Mailing Address - Phone:419-677-9010
Mailing Address - Fax:
Practice Address - Street 1:2275 GREENWICH MILAN TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-9509
Practice Address - Country:US
Practice Address - Phone:419-677-9010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRQ966024172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver