Individual
STELLA WAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
13357 SOUTH ST, CERRITOS, CA 90703-7308
(562) 379-8000
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
95007150
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95007150
NP LICENSE/REGISTRATION/FURNISHING
CA
01
—
AG06170323
AGNP CERTIFICATION
—
Enumeration date
08/20/2017
Last updated
10/01/2025
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