Individual
FAYE YETTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2015 W AUSTIN DR, PEORIA, IL 61614-3910
(309) 256-0632
Mailing address
2015 W AUSTIN DR, PEORIA, IL 61614
(309) 256-0632
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
209006898
IL
363LP2300X
Primary Care Nurse Practitioner
209006898
IL
Other
Enumeration date
09/19/2014
Last updated
08/23/2017
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