Provider Demographics
NPI:1790898294
Name:YAHLE, MARY ELLEN (RN, PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:YAHLE
Suffix:
Gender:F
Credentials:RN, PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 E WEBSTER PL
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-4256
Mailing Address - Country:US
Mailing Address - Phone:414-964-9200
Mailing Address - Fax:414-964-4816
Practice Address - Street 1:2524 E WEBSTER PL
Practice Address - Street 2:SUITE 203
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4253
Practice Address - Country:US
Practice Address - Phone:414-964-9200
Practice Address - Fax:414-964-4816
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52259-30364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39405700Medicaid
WI39405700Medicaid