Provider Demographics
NPI:1578758710
Name:YANG, MAI DER (RN)
Entity Type:Individual
Prefix:
First Name:MAI DER
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38363 GOLDEN OAKS TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5839
Mailing Address - Country:US
Mailing Address - Phone:651-488-3126
Mailing Address - Fax:651-487-7637
Practice Address - Street 1:38363 GOLDEN OAKS TRL
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5839
Practice Address - Country:US
Practice Address - Phone:651-488-3126
Practice Address - Fax:651-487-7637
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 181654-9163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health