Provider Demographics
NPI:1023740156
Name:YUAN, LIJUAN (CRNP)
Entity type:Individual
Prefix:
First Name:LIJUAN
Middle Name:
Last Name:YUAN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 OAKFORD CIR
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3822
Mailing Address - Country:US
Mailing Address - Phone:215-485-2723
Mailing Address - Fax:
Practice Address - Street 1:2010 W CHESTER PIKE STE 448
Practice Address - Street 2:
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-2741
Practice Address - Country:US
Practice Address - Phone:610-853-2502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025810363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care