Healthcare Provider Details

I. General information

NPI: 1508557323
Provider Name (Legal Business Name): KUO SHENG YANG DNP, APNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 07/25/2023
Certification Date: 07/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 SPRING ST
MOUNT PLEASANT WI
53406-2632
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-504-3100
  • Fax:
Mailing address:
  • Phone: 262-504-3100
  • Fax: 262-504-3115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13519
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13519-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: