Healthcare Provider Details

I. General information

NPI: 1043324247
Provider Name (Legal Business Name): GRACE HSUANHWA WANG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 W. MAIN STREET
MANCHESTER IA
52057-0359
US

IV. Provider business mailing address

709 W. MAIN STREET, P.O. BOX 359
MANCHESTER IA
52057-0359
US

V. Phone/Fax

Practice location:
  • Phone: 563-927-7698
  • Fax: 563-927-7469
Mailing address:
  • Phone: 563-927-7698
  • Fax: 563-927-7469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036102794
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD-45432
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: