Provider Demographics
NPI:1639916810
Name:YEAGER, ELLIANA JULIET
Entity type:Individual
Prefix:
First Name:ELLIANA
Middle Name:JULIET
Last Name:YEAGER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-3725
Mailing Address - Country:US
Mailing Address - Phone:724-516-6754
Mailing Address - Fax:
Practice Address - Street 1:6 REGIONAL DR STE D
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9868
Practice Address - Country:US
Practice Address - Phone:910-221-7195
Practice Address - Fax:910-221-7195
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2025-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant