Provider Demographics
NPI:1285972885
Name:QIAO, XIANWEN (CRNP)
Entity type:Individual
Prefix:
First Name:XIANWEN
Middle Name:
Last Name:QIAO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 MILL RUN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1532
Mailing Address - Country:US
Mailing Address - Phone:724-349-0670
Mailing Address - Fax:
Practice Address - Street 1:625 RUSTIC LODGE RD
Practice Address - Street 2:STE B
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3440
Practice Address - Country:US
Practice Address - Phone:724-463-3720
Practice Address - Fax:724-463-6111
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP012605363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PANUMBER PENDINGMedicaid
PANUMBER PENDINGMedicare PIN