Provider Demographics
NPI:1326404393
Name:LI, MIAOJUAN (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:MIAOJUAN
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 FAIRWAY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6537
Mailing Address - Country:US
Mailing Address - Phone:972-492-8880
Mailing Address - Fax:972-492-8818
Practice Address - Street 1:4100 FAIRWAY DR STE 300
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010
Practice Address - Country:US
Practice Address - Phone:972-492-8880
Practice Address - Fax:972-492-8818
Is Sole Proprietor?:No
Enumeration Date:2016-01-06
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129889363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics