Provider Demographics
NPI:1780044636
Name:YANG, JOUA PA
Entity Type:Individual
Prefix:
First Name:JOUA
Middle Name:PA
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 IMPERIAL CIR
Mailing Address - Street 2:APT 415
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4596
Mailing Address - Country:US
Mailing Address - Phone:715-450-4588
Mailing Address - Fax:
Practice Address - Street 1:1117 IMPERIAL CIR
Practice Address - Street 2:APT 415
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4596
Practice Address - Country:US
Practice Address - Phone:715-450-4588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31573431164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse