Provider Demographics
NPI:1447585658
Name:LWANG, CHARLES K (RN)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:K
Last Name:LWANG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 NOTTINGHAM CT
Mailing Address - Street 2:APT 509
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01905-3131
Mailing Address - Country:US
Mailing Address - Phone:617-642-9006
Mailing Address - Fax:
Practice Address - Street 1:28 NOTTINGHAM CT
Practice Address - Street 2:APT 509
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01905-3131
Practice Address - Country:US
Practice Address - Phone:617-642-9006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2009-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262126163W00000X
NH014846-22164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse