Healthcare Provider Details

I. General information

NPI: 1205901576
Provider Name (Legal Business Name): NKAUJNEEB M YANG R.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

277 UNIVERSITY AVE W SUITE 200A
SAINT PAUL MN
55103-2048
US

IV. Provider business mailing address

1828 153RD AVE NE
HAM LAKE MN
55304-5725
US

V. Phone/Fax

Practice location:
  • Phone: 651-261-6381
  • Fax: 651-793-6791
Mailing address:
  • Phone: 651-261-6381
  • Fax: 651-793-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number333663
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR 172377-1
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberR 172377-1
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: