Provider Demographics
NPI:1477876449
Name:CHILDREN'S HOSPITAL OF WISONSIN
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL OF WISONSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DANVERS
Authorized Official - Last Name:YUAN
Authorized Official - Suffix:
Authorized Official - Credentials:NNP-BC,APNP
Authorized Official - Phone:414-266-2950
Mailing Address - Street 1:6601 CASCADE AVE
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1971
Mailing Address - Country:US
Mailing Address - Phone:310-995-7642
Mailing Address - Fax:
Practice Address - Street 1:6601 CASCADE AVE
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1971
Practice Address - Country:US
Practice Address - Phone:310-995-7642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-05
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3834033282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren