Provider Demographics
NPI:1629649942
Name:YANKE, MARIA KATHLEEN (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:KATHLEEN
Last Name:YANKE
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 DEMPSEY RD APT 104
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53714-3052
Mailing Address - Country:US
Mailing Address - Phone:570-317-7845
Mailing Address - Fax:
Practice Address - Street 1:1515 HOMMEN RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:WI
Practice Address - Zip Code:53531-9678
Practice Address - Country:US
Practice Address - Phone:608-444-0774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261265-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse