Provider Demographics
NPI:1427467596
Name:YANG, MARIE (LPN)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3431 N 10TH ST APT 721
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-3133
Mailing Address - Country:US
Mailing Address - Phone:414-690-5052
Mailing Address - Fax:
Practice Address - Street 1:3431 N 10TH ST APT 721
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-3133
Practice Address - Country:US
Practice Address - Phone:414-690-5052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-03
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI316807-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse