Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0024167167 | VA |
NPI | 1023360427 |
---|---|
Provider Name | Ms. Xin Wang |
First Address | Fairfax, VA 22030-5115 |
Second Address | Fairfax, VA 22030-5115 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2012 |
Last Update Date | 09/10/2012 |