Provider Demographics
NPI:1689149809
Name:WANG, QUAN JAMES (FNP)
Entity Type:Individual
Prefix:
First Name:QUAN JAMES
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12065 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45249-1728
Mailing Address - Country:US
Mailing Address - Phone:513-239-6854
Mailing Address - Fax:513-293-8994
Practice Address - Street 1:12065 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-1728
Practice Address - Country:US
Practice Address - Phone:513-239-6854
Practice Address - Fax:513-293-8994
Is Sole Proprietor?:No
Enumeration Date:2018-10-04
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021731208VP0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine