Provider Demographics
NPI:1881859742
Name:OUELLETTE, E YVONNE (LMT)
Entity Type:Individual
Prefix:
First Name:E
Middle Name:YVONNE
Last Name:OUELLETTE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 LIPMAN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-3673
Mailing Address - Country:US
Mailing Address - Phone:843-901-0182
Mailing Address - Fax:843-875-7116
Practice Address - Street 1:121 LIPMAN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-3673
Practice Address - Country:US
Practice Address - Phone:843-901-0182
Practice Address - Fax:843-875-7116
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2010-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4402174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist