Healthcare Provider Details

I. General information

NPI: 1033650080
Provider Name (Legal Business Name): MICAELA R YU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2017
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 N MEMORIAL DR
LANCASTER OH
43130-1632
US

IV. Provider business mailing address

104 HOOVER ST
NEWARK OH
43055-5141
US

V. Phone/Fax

Practice location:
  • Phone: 405-695-9580
  • Fax:
Mailing address:
  • Phone: 405-695-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50.009388RX
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: