Provider Demographics
NPI:1205187275
Name:WU, WAN-JU (ACNP)
Entity Type:Individual
Prefix:
First Name:WAN-JU
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14359 E 12 MILE RD APT C
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-3854
Mailing Address - Country:US
Mailing Address - Phone:513-328-0346
Mailing Address - Fax:
Practice Address - Street 1:14359 E 12 MILE RD APT C
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-3854
Practice Address - Country:US
Practice Address - Phone:513-328-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-30
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704268334363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care