Provider Demographics
NPI:1932894144
Name:WANG, JULIA MARIE
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MARIE
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4511 KELLIWOOD MANOR LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6813
Mailing Address - Country:US
Mailing Address - Phone:662-279-0667
Mailing Address - Fax:
Practice Address - Street 1:4301 WEST MARKHAM
Practice Address - Street 2:SLOT 500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-686-5838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program