Basic Information
| Provider Information | |||||||||
| NPI: | 1982667218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YOST | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | |||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 WOODLAND DR | ||||||||
| Address2: | |||||||||
| City: | COOS BAY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974202045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412675151 | ||||||||
| FaxNumber: | 5412672233 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 10TH ST SE | ||||||||
| Address2: | |||||||||
| City: | BANDON | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974119157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412675151 | ||||||||
| FaxNumber: | 5412672233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2006 | ||||||||
| LastUpdateDate: | 12/11/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | NP11037 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 1407812365 | 01 | OR | MEDICARE GROUP NPI NUMBER | OTHER | CB3544 | 01 | OR | RR MEDICARE GROUP NUMBER | OTHER | 0577260001 | 01 | OR | DMERC | OTHER | 274383 | 05 | OR | MEDICAID | P00424728 | 01 | OR | RR MEDICARE PTAN | OTHER | R0000WFBTV | 01 | OR | MEDICARE GROUP PIN NUMBER | OTHER |