Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 17143 | NV |
NPI | 1154610137 |
---|---|
Provider Name | Olivia J Wang |
First Address | Las Vegas, NV 89147-6721 |
Second Address | Las Vegas, NV 89147-6721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2011 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
17143 | NEVADA STATE BOARD OF MEDICAL EXAMINERS (01) | NV |
CS25988 | NEVADA STATE BOARD OF PHARMACY (01) | NV |