Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 6166 | AK |
NPI | 1780616680 |
---|---|
Provider Name | Andrea Susan Wang |
First Address | Anchorage, AK 99508-4608 |
Second Address | Anchorage, AK 99508-4608 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 31/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I10413 | (02) | NY |