Healthcare Provider Details

I. General information

NPI: 1467263152
Provider Name (Legal Business Name): IVANNA YAU NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2025
Last Update Date: 01/16/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 ORCHARD RD STE 320C
WEST BLOOMFIELDS MI
48322
US

IV. Provider business mailing address

1591 OXFORD RD
BERKLEY MI
48072-2029
US

V. Phone/Fax

Practice location:
  • Phone: 248-483-0345
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704381402
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704381402
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: