Provider Demographics
NPI:1124114368
Name:YARKER, ROSEANNA D (LPN)
Entity type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:D
Last Name:YARKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LINESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16424-6671
Mailing Address - Country:US
Mailing Address - Phone:814-722-5575
Mailing Address - Fax:
Practice Address - Street 1:2409 N SHORE DR
Practice Address - Street 2:
Practice Address - City:LINESVILLE
Practice Address - State:PA
Practice Address - Zip Code:16424-6671
Practice Address - Country:US
Practice Address - Phone:814-722-5575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN105203164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2275667Medicaid