Provider Demographics
NPI:1871334367
Name:YANG, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
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 1:3200 PROVIDENCE DR
Mailing Address - Street 2:C/O EMERGENCY DEPARTMENT
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4615
Mailing Address - Country:US
Mailing Address - Phone:907-212-7860
Mailing Address - Fax:907-212-7821
Practice Address - Street 1:3200 PROVIDENCE DR
Practice Address - Street 2:DEPARTMENT OF NURSING EXCELLENCE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4615
Practice Address - Country:US
Practice Address - Phone:907-212-7860
Practice Address - Fax:907-212-7821
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK206811163WE0003X
AK207269364SE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SE0003XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistEmergency
No163WE0003XNursing Service ProvidersRegistered NurseEmergency