Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP60493638 | WA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP60493638 | WA |
NPI | 1083022123 |
---|---|
Provider Name | Jungjoo Yi |
First Address | Puyallup, WA 98374-2761 |
Second Address | Puyallup, WA 98374-2761 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2014 |
Last Update Date | 24/06/2021 |