Provider Demographics
NPI:1649057068
Name:PAK, YUNIE GRACE (RN)
Entity type:Individual
Prefix:
First Name:YUNIE
Middle Name:GRACE
Last Name:PAK
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 1:1305 IRELAND DR APT A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-4332
Mailing Address - Country:US
Mailing Address - Phone:443-880-1604
Mailing Address - Fax:
Practice Address - Street 1:1305 IRELAND DR APT A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-4332
Practice Address - Country:US
Practice Address - Phone:443-880-1604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC325080163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse