Provider Demographics
NPI:1174381156
Name:YEAGER, ELIZABETH KELLY
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KELLY
Last Name:YEAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5055 SAN LUIS REY DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-2813
Mailing Address - Country:US
Mailing Address - Phone:419-277-7787
Mailing Address - Fax:
Practice Address - Street 1:4834 BOWEN RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-3254
Practice Address - Country:US
Practice Address - Phone:419-277-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-13
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care