Provider Demographics
NPI:1124906383
Name:HOLLEY, YUMIKO (RN)
Entity type:Individual
Prefix:MS
First Name:YUMIKO
Middle Name:
Last Name:HOLLEY
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 1:4950 N 48TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-4421
Mailing Address - Country:US
Mailing Address - Phone:414-810-7811
Mailing Address - Fax:
Practice Address - Street 1:13111 N PORT WASHINGTON RD FL 2
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53097-2416
Practice Address - Country:US
Practice Address - Phone:262-292-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV875834163WG0000X
WI1106854163WG0000X
CARN9538250163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice