Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | F304674 | NY |
NPI | 1073065421 |
---|---|
Provider Name | Chia-Chen Wu |
First Address | Rego Park, NY 11374-4330 |
Second Address | Flushing, NY 11355-3213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2016 |
Last Update Date | 02/11/2016 |