Provider Demographics
NPI:1194863050
Name:WASAN, NAINA (PAC)
Entity Type:Individual
Prefix:
First Name:NAINA
Middle Name:
Last Name:WASAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201606
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-1606
Mailing Address - Country:US
Mailing Address - Phone:972-758-3598
Mailing Address - Fax:972-599-9604
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-3629
Practice Address - Country:US
Practice Address - Phone:972-420-1576
Practice Address - Fax:972-420-1850
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04819363A00000X
TXPA04619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282055702Medicaid
TX282055703Medicaid
TXP00987195OtherRAILROAD
TX282055701Medicaid
TXTXB124193Medicare PIN
TXP00987195OtherRAILROAD
TX282055701Medicaid