Healthcare Provider Details

I. General information

NPI: 1659017184
Provider Name (Legal Business Name): YUAN-JANE QIU PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 05/25/2022
Certification Date: 05/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7825 BALLANTYNE COMMONS PKWY STE 300
CHARLOTTE NC
28277-3175
US

IV. Provider business mailing address

7825 BALLANTYNE COMMONS PKWY STE 300
CHARLOTTE NC
28277-3175
US

V. Phone/Fax

Practice location:
  • Phone: 704-544-8776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4170
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number027589
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-12022
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: