Provider Demographics
NPI:1144874074
Name:WANG, PEIXIN (CRNA)
Entity type:Individual
Prefix:
First Name:PEIXIN
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 CITATION DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9151
Mailing Address - Country:US
Mailing Address - Phone:678-779-9850
Mailing Address - Fax:
Practice Address - Street 1:65 CAMP DR
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-8837
Practice Address - Country:US
Practice Address - Phone:678-779-9850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-29
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN236953163W00000X, 367500000X
NC290433163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse