Provider Demographics
NPI:1427600071
Name:SU, WANNIN (NCLB)
Entity type:Individual
Prefix:
First Name:WANNIN
Middle Name:
Last Name:SU
Suffix:
Gender:F
Credentials:NCLB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7009 RIO TAMEGA DR
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5921
Mailing Address - Country:US
Mailing Address - Phone:916-882-5238
Mailing Address - Fax:
Practice Address - Street 1:7009 RIO TAMEGA DR
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5921
Practice Address - Country:US
Practice Address - Phone:916-882-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter