Provider Demographics
NPI:1558655571
Name:YONGA, JEAN L (RN)
Entity Type:Individual
Prefix:MR
First Name:JEAN
Middle Name:L
Last Name:YONGA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:60 S TERRACE DR
Mailing Address - Street 2:# 2
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3629
Mailing Address - Country:US
Mailing Address - Phone:513-563-0412
Mailing Address - Fax:513-563-0412
Practice Address - Street 1:60 S TERRACE DR
Practice Address - Street 2:# 2
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3629
Practice Address - Country:US
Practice Address - Phone:513-563-0412
Practice Address - Fax:513-563-0412
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-144208-M-IV164W00000X
OHRN.437541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse