Provider Demographics
NPI:1205047339
Name:YASKO, AMY
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:
Last Name:YASKO
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 1:184 BIRD HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-5905
Mailing Address - Country:US
Mailing Address - Phone:207-875-2393
Mailing Address - Fax:207-875-2395
Practice Address - Street 1:184 BIRD HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-5905
Practice Address - Country:US
Practice Address - Phone:207-875-2393
Practice Address - Fax:207-875-2395
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNAT1000443175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath