Individual
NICOLE LYEMONE YEATS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EFDA
Contact information
Practice address
5025 SE 28TH AVE, PORTLAND, OR 97202-4445
(503) 238-4418
Mailing address
5025 SE 28TH AVE, PORTLAND, OR 97202-4445
(503) 238-4418
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
113515
OR
Other
Enumeration date
11/28/2016
Last updated
11/28/2016
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