Provider Demographics
NPI:1902571805
Name:WANG, BEVERLY (CNP)
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PAYSON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FOXBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02035-1309
Mailing Address - Country:US
Mailing Address - Phone:781-551-5812
Mailing Address - Fax:508-698-8671
Practice Address - Street 1:9 PAYSON RD STE 100
Practice Address - Street 2:
Practice Address - City:FOXBORO
Practice Address - State:MA
Practice Address - Zip Code:02035-1309
Practice Address - Country:US
Practice Address - Phone:781-551-5812
Practice Address - Fax:508-698-8671
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2339631363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner