Individual
FAN WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
Mailing address
4100 W 3RD ST, DAYTON, OH 45428-9000
(937) 268-6511
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN. 306942
OH
363L00000X
Nurse Practitioner
11428NP
OH
363LF0000X
Family Nurse Practitioner
Primary
11428-NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0058596
—
OH
01
—
11428NP
OHIO LICENSE
OH
Enumeration date
02/07/2008
Last updated
12/11/2015
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