MEDICARE: MS. JULIANA MICHELLE YIM LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	LPN-12559	HI

General Provider Information

NPI Number	:	1801813522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIANA MICHELLE YIM LPN

Provider Business Mailing Address
First Line	:	5339 PALMYRA CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3504
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5339 PALMYRA CT
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3504
Country	:	US
Telephone Number	:	757-572-5939
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	06/26/2009

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