Individual
ADA WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
486 W BOUGHTON RD # B, BOLINGBROOK, IL 60440-2399
(630) 755-5278
Mailing address
486 W BOUGHTON RD # B, BOLINGBROOK, IL 60440-2399
(630) 755-5278
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
209013068
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209013068
STATE LICENSE
IL
Enumeration date
05/09/2016
Last updated
05/15/2025
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