Healthcare Provider Details

I. General information

NPI: 1184534067
Provider Name (Legal Business Name): RUOYU WAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 IOWA ST
LAWRENCE KS
66046-5206
US

IV. Provider business mailing address

1301 W 24TH ST APT I12
LAWRENCE KS
66046-5734
US

V. Phone/Fax

Practice location:
  • Phone: 785-842-0177
  • Fax:
Mailing address:
  • Phone: 765-772-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3-121403
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: