Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 209006898 | IL |
N | 363LP2300X | Nurse Practitioner - Primary Care | 209006898 | IL |
NPI | 1003218116 |
---|---|
Provider Name | Faye Yetton |
First Address | Peoria, IL 61614 |
Second Address | Peoria, IL 61614-3910 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2014 |
Last Update Date | 23/08/2017 |