Provider Demographics
NPI:1649430620
Name:YODER, KRISTINA NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:NICOLE
Last Name:YODER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4480 UTICA RIDGE RD
Mailing Address - Street 2:SUITE 1140
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1656
Mailing Address - Country:US
Mailing Address - Phone:563-742-5700
Mailing Address - Fax:563-742-5705
Practice Address - Street 1:4480 UTICA RIDGE RD
Practice Address - Street 2:SUITE 1140
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1656
Practice Address - Country:US
Practice Address - Phone:563-742-5700
Practice Address - Fax:563-742-5705
Is Sole Proprietor?:No
Enumeration Date:2008-06-12
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5315036300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1649430620Medicaid
IA1649430620Medicaid