Provider Demographics
NPI:1093277402
Name:YANG, PANG NYA (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PANG
Middle Name:NYA
Last Name:YANG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:PANG
Other - Middle Name:N
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:122 E COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-5794
Mailing Address - Country:US
Mailing Address - Phone:920-996-3264
Mailing Address - Fax:920-830-5970
Practice Address - Street 1:2500 E CAPITOL DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911
Practice Address - Country:US
Practice Address - Phone:920-738-4600
Practice Address - Fax:920-738-4792
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily