Healthcare Provider Details

I. General information

NPI: 1487190153
Provider Name (Legal Business Name): XUE YANG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2017
Last Update Date: 12/11/2020
Certification Date: 12/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 W EL PORTAL DR
MERCED CA
95348-2853
US

IV. Provider business mailing address

PO BOX 3768
MERCED CA
95344-3768
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-3704
  • Fax: 209-723-0272
Mailing address:
  • Phone: 209-725-7149
  • Fax: 209-726-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95004818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: