Basic Information
| Provider Information | |||||||||
| NPI: | 1730156522 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GAYHART | ||||||||
| FirstName: | YVONNE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 W MAIN CROSS ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458402423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194241393 | ||||||||
| FaxNumber: | 4194243424 | ||||||||
| Practice Location | |||||||||
| Address1: | 1110 W MAIN CROSS ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458402423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194241393 | ||||||||
| FaxNumber: | 4194243424 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 50001712 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 50001712 | 01 | OH | OHIO STATE LICENSE | OTHER |