Provider Demographics
NPI:1306951314
Name:WANN, LI-CHEN L (NP)
Entity type:Individual
Prefix:MRS
First Name:LI-CHEN
Middle Name:L
Last Name:WANN
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 1:410 LAKEVILLE RD, SUITE 107
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-465-5419
Mailing Address - Fax:516-465-5454
Practice Address - Street 1:410 LAKEVILLE RD, SUITE 107
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-465-5419
Practice Address - Fax:516-465-5454
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301307 / 412733163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
1505G1Medicare ID - Type Unspecified
Q62629Medicare UPIN