Provider Demographics
NPI:1275415572
Name:CHRISTIAN, YETTA
Entity type:Individual
Prefix:
First Name:YETTA
Middle Name:
Last Name:CHRISTIAN
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 1:5911 WEST STATE RD. 46
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429
Mailing Address - Country:US
Mailing Address - Phone:317-828-3502
Mailing Address - Fax:
Practice Address - Street 1:5911 WEST STATE RD 46
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429
Practice Address - Country:US
Practice Address - Phone:317-828-3502
Practice Address - Fax:317-828-3502
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28244745A163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator