Provider Demographics
NPI:1760453203
Name:HIRAO-TRY, YUMIKO (NP)
Entity Type:Individual
Prefix:
First Name:YUMIKO
Middle Name:
Last Name:HIRAO-TRY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:YUMIKO
Other - Middle Name:
Other - Last Name:HIRAO TRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:200 1ST ST SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55905-0001
Mailing Address - Country:US
Mailing Address - Phone:507-284-2511
Mailing Address - Fax:
Practice Address - Street 1:200 1ST ST SW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55905-0001
Practice Address - Country:US
Practice Address - Phone:507-284-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR141051-8363L00000X
MN1878363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MN108239600Medicaid
IAENROLLEDMedicaid
WI36074000Medicaid
IAENROLLEDMedicaid
WI36074000Medicaid
MN500002386Medicare PIN