Provider Demographics
NPI:1609171321
Name:CUPPETT, YVONNE LAROSE (CD(DONA))
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:LAROSE
Last Name:CUPPETT
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:MRS
Other - First Name:YVONNE
Other - Middle Name:LAROSE
Other - Last Name:CUPPETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1241 COLLIER RD
Mailing Address - Street 2:
Mailing Address - City:ACCIDENT
Mailing Address - State:MD
Mailing Address - Zip Code:21520-1338
Mailing Address - Country:US
Mailing Address - Phone:301-746-8055
Mailing Address - Fax:301-746-8055
Practice Address - Street 1:1241 COLLIER RD
Practice Address - Street 2:
Practice Address - City:ACCIDENT
Practice Address - State:MD
Practice Address - Zip Code:21520-1338
Practice Address - Country:US
Practice Address - Phone:301-746-8055
Practice Address - Fax:301-746-8055
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-12
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDROO146225700000X
WV2004-1394225700000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula