Provider Demographics
NPI:1588200547
Name:YANG, PADER (RN)
Entity Type:Individual
Prefix:
First Name:PADER
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 1:1736 COPE AVE E STE 2
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55109-2661
Mailing Address - Country:US
Mailing Address - Phone:952-456-6561
Mailing Address - Fax:
Practice Address - Street 1:1736 COPE AVE E STE 2
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55109-2661
Practice Address - Country:US
Practice Address - Phone:952-456-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2474504163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health