Provider Demographics
NPI:1265979058
Name:SACDALAN, SUE YARNG (MSN, RN, NP-C)
Entity type:Individual
Prefix:
First Name:SUE
Middle Name:YARNG
Last Name:SACDALAN
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:9044 OAKRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SHELBY TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1824
Mailing Address - Country:US
Mailing Address - Phone:248-891-5812
Mailing Address - Fax:
Practice Address - Street 1:1375 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1350
Practice Address - Country:US
Practice Address - Phone:810-667-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-31
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704216287363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner