Provider Demographics
NPI:1528515954
Name:YURK, MOLLY (NP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:YURK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:LOKKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:S68W15500 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-2613
Mailing Address - Country:US
Mailing Address - Phone:414-422-4000
Mailing Address - Fax:
Practice Address - Street 1:S68W15500 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-2613
Practice Address - Country:US
Practice Address - Phone:414-422-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7220-33363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1528515954Medicaid
WI1528515954Medicaid
WIK400360955Medicare PIN