Provider Demographics
NPI:1598583742
Name:YOO, DISA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:DISA
Middle Name:
Last Name:YOO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 985
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180-1010
Mailing Address - Country:US
Mailing Address - Phone:951-255-1581
Mailing Address - Fax:
Practice Address - Street 1:CMR 402 BOX 985
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09180-1010
Practice Address - Country:US
Practice Address - Phone:951-255-1581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT184977163W00000X
CT12673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse