Provider Demographics
NPI:1235183575
Name:YOO, JOANNE YOOSEON (NP)
Entity Type:Individual
Prefix:MS
First Name:JOANNE
Middle Name:YOOSEON
Last Name:YOO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8330 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1640
Mailing Address - Country:US
Mailing Address - Phone:703-258-4765
Mailing Address - Fax:401-652-0009
Practice Address - Street 1:8330 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1640
Practice Address - Country:US
Practice Address - Phone:703-569-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA363LF0000XOtherNOT A GROUP
VAP00091905OtherRAILROAD MEDICARE
VA010051444Medicaid
VA141893ZCCUMedicare PIN
VA010051444Medicaid
VA003669E76Medicare ID - Type Unspecified