Provider Demographics
NPI:1417217514
Name:WANG, WANXIA (RN)
Entity Type:Individual
Prefix:
First Name:WANXIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14705 BROUGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3330
Mailing Address - Country:US
Mailing Address - Phone:301-518-6889
Mailing Address - Fax:
Practice Address - Street 1:14705 BROUGHAM WAY
Practice Address - Street 2:
Practice Address - City:NORTH POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20878-3330
Practice Address - Country:US
Practice Address - Phone:301-518-6889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR200008163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse