Provider Demographics
NPI:1255870523
Name:WU, GUANRU (LAC)
Entity Type:Individual
Prefix:
First Name:GUANRU
Middle Name:
Last Name:WU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 KELLER PKWY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-2302
Mailing Address - Country:US
Mailing Address - Phone:832-497-6360
Mailing Address - Fax:
Practice Address - Street 1:413 KELLER PKWY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2302
Practice Address - Country:US
Practice Address - Phone:817-965-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-19
Last Update Date:2017-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01543171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist