Provider Demographics
NPI:1689162885
Name:WANG, YU (NP)
Entity Type:Individual
Prefix:
First Name:YU
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2431
Mailing Address - Country:US
Mailing Address - Phone:630-809-5695
Mailing Address - Fax:
Practice Address - Street 1:1 JOSLIN PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5306
Practice Address - Country:US
Practice Address - Phone:617-309-2400
Practice Address - Fax:617-309-2734
Is Sole Proprietor?:No
Enumeration Date:2018-04-24
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2322913363LA2200X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health