Provider Demographics
NPI:1033982772
Name:SUN, WANXIN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:WANXIN
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 WARNER DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-0168
Mailing Address - Country:US
Mailing Address - Phone:469-288-9288
Mailing Address - Fax:
Practice Address - Street 1:4100 FAIRWAY DR STE 320
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-6537
Practice Address - Country:US
Practice Address - Phone:972-236-7608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2023064445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine