Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LF0000X | Nurse Practitioner - Family Medicine | 8752 | MN |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 8752 | MN |
NPI | 1003573445 |
---|---|
Provider Name | Dr. Panra Yang |
First Address | Bloomington, MN 55425-4516 |
Second Address | Prior Lake, MN 55372-4119 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2021 |
Last Update Date | 20/01/2022 |