Healthcare Provider Details

I. General information

NPI: 1639328032
Provider Name (Legal Business Name): YING YANG MSN, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 02/28/2020
Certification Date: 02/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

995 OLD EAGLE SCHOOL RD STE 304F
WAYNE PA
19087-1701
US

IV. Provider business mailing address

995 OLD EAGLE SCHOOL RD STE 304F
WAYNE PA
19087-1701
US

V. Phone/Fax

Practice location:
  • Phone: 610-688-3099
  • Fax: 610-687-5350
Mailing address:
  • Phone: 610-688-3099
  • Fax: 610-687-5350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberCOA10230NP
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number10230-NP
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP020372
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2874993
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: