Provider Demographics
NPI:1689837684
Name:XU, QUN (NP)
Entity Type:Individual
Prefix:
First Name:QUN
Middle Name:
Last Name:XU
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 1:260 TOWNSHIP BLVD
Mailing Address - Street 2:STE 20
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-1674
Mailing Address - Country:US
Mailing Address - Phone:315-708-0091
Mailing Address - Fax:315-708-0194
Practice Address - Street 1:260 TOWNSHIP BLVD
Practice Address - Street 2:STE 20
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-1674
Practice Address - Country:US
Practice Address - Phone:315-708-0091
Practice Address - Fax:315-708-0194
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335644363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily