Provider Demographics
NPI:1144595240
Name:WANG, LICHING PI
Entity Type:Individual
Prefix:MRS
First Name:LICHING
Middle Name:PI
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13845 COUNTY ROAD 23
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-8859
Mailing Address - Country:US
Mailing Address - Phone:970-565-0185
Mailing Address - Fax:
Practice Address - Street 1:13845 COUNTY ROAD 23
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-8859
Practice Address - Country:US
Practice Address - Phone:970-565-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2233173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist