Provider Demographics
NPI:1982947446
Name:YETTER, MELISSA (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:YETTER
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 N EASTON BELMONT PIKE
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-7077
Mailing Address - Country:US
Mailing Address - Phone:570-629-6433
Mailing Address - Fax:
Practice Address - Street 1:192 N EASTON BELMONT PIKE
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7077
Practice Address - Country:US
Practice Address - Phone:570-629-6433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN201709L163WL0100X
PA11133208174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No174N00000XOther Service ProvidersLactation Consultant, Non-RN