Provider Demographics
NPI:1457820623
Name:LI, QIYE WENDY (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:QIYE
Middle Name:WENDY
Last Name:LI
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WALNUT ST STE 330
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2154
Mailing Address - Country:US
Mailing Address - Phone:617-630-0380
Mailing Address - Fax:617-630-2026
Practice Address - Street 1:65 WALNUT ST STE 330
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2154
Practice Address - Country:US
Practice Address - Phone:617-630-0380
Practice Address - Fax:617-630-2026
Is Sole Proprietor?:No
Enumeration Date:2018-11-17
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN283060363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily