Individual
AVERY RENUALL YATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
47 CHANDLER ST QUAY WALL, NEWPORT, RI 02842
(270) 727-0103
Mailing address
47 CHANDLER ST QUAY WALL, NEWPORT, RI 02842
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
10/03/2021
Last updated
10/03/2021
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