Provider Demographics
NPI:1972349850
Name:WANG, ROY (BSN, RN, CCRN, SRNA)
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:BSN, RN, CCRN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12813 AMBERWOODS WAY
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5525
Mailing Address - Country:US
Mailing Address - Phone:202-531-3158
Mailing Address - Fax:
Practice Address - Street 1:12813 AMBERWOODS WAY
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5525
Practice Address - Country:US
Practice Address - Phone:202-531-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN296777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse