Provider Demographics
NPI:1134752330
Name:YODER, JEREMY TODD
Entity type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:TODD
Last Name:YODER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 77TH DR SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-5857
Mailing Address - Country:US
Mailing Address - Phone:425-877-3417
Mailing Address - Fax:
Practice Address - Street 1:1316 WALL ST STE 2D
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3942
Practice Address - Country:US
Practice Address - Phone:425-877-3417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-16
Last Update Date:2020-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)