Provider Demographics
NPI:1457696478
Name:YOTIDES, AUDREY LAVERDIERE (BSN, RN)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:LAVERDIERE
Last Name:YOTIDES
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S ALPINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04963-4914
Mailing Address - Country:US
Mailing Address - Phone:207-465-3191
Mailing Address - Fax:
Practice Address - Street 1:155 S ALPINE ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-4914
Practice Address - Country:US
Practice Address - Phone:207-465-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERN41047163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse