Provider Demographics
NPI:1285832949
Name:YOO, JOHN JESSE (MS, RN, CPNP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JESSE
Last Name:YOO
Suffix:
Gender:M
Credentials:MS, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9816 234TH PL SW
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-5662
Mailing Address - Country:US
Mailing Address - Phone:206-629-4424
Mailing Address - Fax:
Practice Address - Street 1:9816 234TH PL SW
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-5662
Practice Address - Country:US
Practice Address - Phone:206-629-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-04
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO167086363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics