Healthcare Provider Details

I. General information

NPI: 1891113270
Provider Name (Legal Business Name): MS. MICHELLE YANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S LEAD AVE
FRESNO CA
93706-2239
US

IV. Provider business mailing address

5555 OAK PARK RD
MARSHALL WI
53559-9670
US

V. Phone/Fax

Practice location:
  • Phone: 608-622-3804
  • Fax:
Mailing address:
  • Phone: 608-622-3804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: