Healthcare Provider Details

I. General information

NPI: 1689507865
Provider Name (Legal Business Name): CAILIN YOOSE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 BECKER AVE SW
WILLMAR MN
56201-3302
US

IV. Provider business mailing address

6902 60TH ST NE
SPICER MN
56288-9635
US

V. Phone/Fax

Practice location:
  • Phone: 320-905-2002
  • Fax:
Mailing address:
  • Phone: 320-905-2002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number2537389
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: