Provider Demographics
NPI:1851177364
Name:FERNANDEZ, WAN JUNG LEE (RN, BSN)
Entity Type:Individual
Prefix:MRS
First Name:WAN JUNG
Middle Name:LEE
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11515 SLICK ROCK DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1471
Mailing Address - Country:US
Mailing Address - Phone:832-228-7602
Mailing Address - Fax:
Practice Address - Street 1:23331 GRAND RESERVE DR
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-4850
Practice Address - Country:US
Practice Address - Phone:281-505-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX836470163WG0600X, 163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care
No163WG0600XNursing Service ProvidersRegistered NurseGerontology