Provider Demographics
NPI:1679685010
Name:YATES, MARLENE
Entity type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:
Last Name:YATES
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 1:4199 MASSILLON RD
Mailing Address - Street 2:LOT 212
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8748
Mailing Address - Country:US
Mailing Address - Phone:330-896-0854
Mailing Address - Fax:330-896-0854
Practice Address - Street 1:4199 MASSILLON RD
Practice Address - Street 2:LOT 212
Practice Address - City:UNIONTOWN
Practice Address - State:OH
Practice Address - Zip Code:44685-8748
Practice Address - Country:US
Practice Address - Phone:330-896-0854
Practice Address - Fax:330-896-0854
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2165204Medicaid