Provider Demographics
NPI:1558240119
Name:WEN, LIJUAN (FNP)
Entity type:Individual
Prefix:
First Name:LIJUAN
Middle Name:
Last Name:WEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 WATERSTONE DR FL 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2826
Mailing Address - Country:US
Mailing Address - Phone:929-280-6075
Mailing Address - Fax:
Practice Address - Street 1:1508 WATERSTONE DR FL 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2826
Practice Address - Country:US
Practice Address - Phone:929-280-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY356374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily