Provider Demographics
NPI:1205451853
Name:WANG, QUYNH CHAU BAO (APRN)
Entity type:Individual
Prefix:
First Name:QUYNH
Middle Name:CHAU BAO
Last Name:WANG
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4789
Mailing Address - Country:US
Mailing Address - Phone:936-355-6035
Mailing Address - Fax:
Practice Address - Street 1:1024 BOULDER DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72210-4789
Practice Address - Country:US
Practice Address - Phone:936-355-6035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR124430363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology