Provider Demographics
NPI:1912905332
Name:YODER, DORIS A (CRNP)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:A
Last Name:YODER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 NEW HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2163
Mailing Address - Country:US
Mailing Address - Phone:888-769-3992
Mailing Address - Fax:888-769-3992
Practice Address - Street 1:1569 STONEMILL DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:PA
Practice Address - Zip Code:17022-9439
Practice Address - Country:US
Practice Address - Phone:888-769-3992
Practice Address - Fax:888-769-3992
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-09
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAUP001377B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077684Medicare ID - Type Unspecified
PAQ12448Medicare UPIN