Provider Demographics
NPI:1912256033
Name:WANG, YAN (FNP-BC, DCNP, MSN)
Entity type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:FNP-BC, DCNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 KILBURN RD S
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-5326
Mailing Address - Country:US
Mailing Address - Phone:917-962-7920
Mailing Address - Fax:
Practice Address - Street 1:13259 41ST RD STE CB
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4256
Practice Address - Country:US
Practice Address - Phone:917-962-7920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY983710053OtherDRIVER LICENSE