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Individual
KEVIN WANGA
Active
Individual
KEVIN WANGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN653205
PA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
SP016803
PA
Other
Enumeration date
03/11/2014
Last updated
12/27/2018
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