Provider Demographics
NPI:1548734833
Name:DU, XIAOMENG (FNP-BC)
Entity Type:Individual
Prefix:
First Name:XIAOMENG
Middle Name:
Last Name:DU
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13545 ROOSEVELT AVE # 8G
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5336
Mailing Address - Country:US
Mailing Address - Phone:917-943-6193
Mailing Address - Fax:
Practice Address - Street 1:13545 ROOSEVELT AVE # 8G
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5336
Practice Address - Country:US
Practice Address - Phone:917-943-6193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-20
Last Update Date:2019-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF343692-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily