Provider Demographics
NPI:1982667218
Name:YOST, SUZANNE (FNP)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:YOST
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420-2045
Mailing Address - Country:US
Mailing Address - Phone:541-267-5151
Mailing Address - Fax:541-267-2233
Practice Address - Street 1:110 10TH ST SE
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9157
Practice Address - Country:US
Practice Address - Phone:541-267-5151
Practice Address - Fax:541-267-2233
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP11037363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherMEDICARE GROUP NPI NUMBER
ORCB3544OtherRR MEDICARE GROUP NUMBER
OR0577260001OtherDMERC
OR274383Medicaid
ORP00424728OtherRR MEDICARE PTAN
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
ORR0000WFBTVOtherMEDICARE GROUP PIN NUMBER
OR1407812365OtherMEDICARE GROUP NPI NUMBER
ORP00424728OtherRR MEDICARE PTAN