Provider Demographics
NPI:1316483076
Name:MA, YONGJIE
Entity type:Individual
Prefix:
First Name:YONGJIE
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3838 N OAKLAND AVE
Mailing Address - Street 2:APT 274
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211-2258
Mailing Address - Country:US
Mailing Address - Phone:414-306-1961
Mailing Address - Fax:
Practice Address - Street 1:3838 N OAKLAND AVE
Practice Address - Street 2:APT 274
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-2258
Practice Address - Country:US
Practice Address - Phone:414-306-1961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173652163W00000X
WI14437-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse