Provider Demographics
NPI:1619258050
Name:WANG, QIN (ARNP)
Entity Type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 COOPER POINT RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5736
Mailing Address - Country:US
Mailing Address - Phone:360-486-6710
Mailing Address - Fax:
Practice Address - Street 1:1620 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5736
Practice Address - Country:US
Practice Address - Phone:360-486-6710
Practice Address - Fax:360-705-0269
Is Sole Proprietor?:No
Enumeration Date:2011-08-30
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61264265363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0079857Medicaid
OHH203050Medicare PIN