Provider Demographics
NPI:1194249524
Name:VANDER YACHT, KORI L (NP)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:L
Last Name:VANDER YACHT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:608-829-5247
Mailing Address - Fax:608-833-0999
Practice Address - Street 1:600 N 8TH ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOREB
Practice Address - State:WI
Practice Address - Zip Code:53572-1870
Practice Address - Country:US
Practice Address - Phone:608-437-3064
Practice Address - Fax:608-437-4542
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2021-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI7783-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily