Healthcare Provider Details

I. General information

NPI: 1912487117
Provider Name (Legal Business Name): NANCY WENZHOU CAO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 YORK AVE
NEW YORK NY
10065-4805
US

IV. Provider business mailing address

5667 136TH ST FL 1
FLUSHING NY
11355-5028
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-5454
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number343491
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: