Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 737125 | TX |
NPI | 1063838472 |
---|---|
Provider Name | Yu Wang |
First Address | Katy, TX 77450-7127 |
Second Address | Katy, TX 77450-7127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 12/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
APPLIED FOR | APPLIED FOR (01) |