Provider Demographics
NPI:1205592425
Name:YANG, MIKAR
Entity type:Individual
Prefix:
First Name:MIKAR
Middle Name:
Last Name:YANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 S 24TH ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53204-2503
Mailing Address - Country:US
Mailing Address - Phone:414-316-8692
Mailing Address - Fax:414-763-0238
Practice Address - Street 1:1408 S 24TH ST UNIT 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53204-2503
Practice Address - Country:US
Practice Address - Phone:414-316-8692
Practice Address - Fax:414-763-0238
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10712-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily