Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 6273-33 | WI |
NPI | 1083000160 |
---|---|
Provider Name | Kyungsook Yoon |
First Address | Greendale, WI 53129-2452 |
Second Address | Milwaukee, WI 53222-5003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 15/04/2015 |