Provider Demographics
NPI:1134973308
Name:YANG, AMY (RN)
Entity type:Individual
Prefix:
First Name:AMY
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 1:609 S 56TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3880
Mailing Address - Country:US
Mailing Address - Phone:715-212-3607
Mailing Address - Fax:
Practice Address - Street 1:609 S 56TH AVE APT 1
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3880
Practice Address - Country:US
Practice Address - Phone:715-212-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI265782163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse