Healthcare Provider Details

I. General information

NPI: 1275291833
Provider Name (Legal Business Name): YEN SUN MEIER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2021
Last Update Date: 12/01/2021
Certification Date: 12/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 N RICHMOND ST
APPLETON WI
54911-3567
US

IV. Provider business mailing address

1629 N RICHMOND ST
APPLETON WI
54911-3567
US

V. Phone/Fax

Practice location:
  • Phone: 920-903-1205
  • Fax:
Mailing address:
  • Phone: 920-903-1205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14228-146
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: