MEDICARE: YONGJIE MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	173652	WI
2	363L00000X	Nurse Practitioner	14437-33	WI

General Provider Information

NPI Number	:	1316483076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YONGJIE MA

Provider Business Mailing Address
First Line	:	3838 N OAKLAND AVE
Second Line	:	APT 274
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-2258
Country	:	US
Telephone Number	:	414-306-1961
Fax Number	:

Provider Business Practice Location Address
First Line	:	3838 N OAKLAND AVE
Second Line	:	APT 274
City	:	MILWAUKEE
State	:	WI
Zip	:	53211-2258
Country	:	US
Telephone Number	:	414-306-1961
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	08/29/2023

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Directions to “ YONGJIE MA ” Practice Location

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