Provider Demographics
NPI:1174356604
Name:WANG, QIANQIAN (NP)
Entity type:Individual
Prefix:
First Name:QIANQIAN
Middle Name:
Last Name:WANG
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 1:588 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-4057
Mailing Address - Country:US
Mailing Address - Phone:518-785-2662
Mailing Address - Fax:518-786-6547
Practice Address - Street 1:588 NEW LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-4057
Practice Address - Country:US
Practice Address - Phone:518-785-2662
Practice Address - Fax:518-786-6547
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2918828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily