Individual
NICOLE FAYE YESHTOKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
22232 WILBORN AVE STE C, SOUTH BOSTON, VA 24592-1662
(434) 517-3910
(434) 517-3912
Mailing address
2232 WILBORN AVE STE C, SOUTH BOSTON, VA 24592-1662
(434) 517-3910
(434) 517-3912
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
0102203996
VA
208600000X
Surgery Physician
0T013281
PA
208600000X
Surgery Physician
2020-04156
NC
Other
Enumeration date
08/20/2009
Last updated
06/28/2024
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