Provider Demographics
NPI:1013936442
Name:YODER, MINDY JOY (NP)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JOY
Last Name:YODER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:JOY
Other - Last Name:THORP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2101 E COLISEUM BLVD
Mailing Address - Street 2:WALB 234
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-1445
Mailing Address - Country:US
Mailing Address - Phone:260-481-5748
Mailing Address - Fax:260-481-5752
Practice Address - Street 1:2101 E COLISEUM BLVD
Practice Address - Street 2:WALB 234
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46805-1445
Practice Address - Country:US
Practice Address - Phone:260-481-5748
Practice Address - Fax:260-481-5752
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000200A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000278944OtherANTHEM
IN200251680Medicaid
IN200251680Medicaid
S66321Medicare UPIN
IN070860BMedicare PIN