Provider Demographics
NPI:1932414703
Name:WAN, CECILIA WING YAN (NP)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:WING YAN
Last Name:WAN
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 1:101 PROFESSIONAL PARK STE A
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-2580
Mailing Address - Country:US
Mailing Address - Phone:919-639-3972
Mailing Address - Fax:
Practice Address - Street 1:101 PROFESSIONAL PARK STE A
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:NC
Practice Address - Zip Code:27565-2580
Practice Address - Country:US
Practice Address - Phone:919-639-3972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004828363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner