Provider Demographics
NPI:1700330024
Name:WANG, WENJIA (FNP)
Entity Type:Individual
Prefix:
First Name:WENJIA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13329 41ST RD STE 2D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3695
Mailing Address - Country:US
Mailing Address - Phone:718-353-4280
Mailing Address - Fax:718-353-1862
Practice Address - Street 1:13329 41ST RD STE 2D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3695
Practice Address - Country:US
Practice Address - Phone:718-353-4280
Practice Address - Fax:718-353-1862
Is Sole Proprietor?:No
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily