Provider Demographics
NPI:1407442205
Name:YANG, DIANA M
Entity Type:Individual
Prefix:MISS
First Name:DIANA
Middle Name:M
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPHT
Mailing Address - Street 1:102 CENTRAL BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2944
Mailing Address - Country:US
Mailing Address - Phone:715-842-0744
Mailing Address - Fax:
Practice Address - Street 1:102 CENTRAL BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2944
Practice Address - Country:US
Practice Address - Phone:715-842-0744
Practice Address - Fax:715-842-0774
Is Sole Proprietor?:No
Enumeration Date:2020-12-15
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
30055776183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician