Provider Demographics
NPI:1295583334
Name:MA, WENXUAN (ED)
Entity type:Individual
Prefix:
First Name:WENXUAN
Middle Name:
Last Name:MA
Suffix:
Gender:F
Credentials:ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 HIGH ST APT B
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-4289
Mailing Address - Country:US
Mailing Address - Phone:205-520-4516
Mailing Address - Fax:
Practice Address - Street 1:24 HIGH ST APT B
Practice Address - Street 2:
Practice Address - City:SABATTUS
Practice Address - State:ME
Practice Address - Zip Code:04280-4289
Practice Address - Country:US
Practice Address - Phone:205-520-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDI1992133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered