Healthcare Provider Details

I. General information

NPI: 1548308570
Provider Name (Legal Business Name): EVA WU PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

IV. Provider business mailing address

1935 MEDICAL DISTRICT DR
DALLAS TX
75235-7701
US

V. Phone/Fax

Practice location:
  • Phone: 214-456-7008
  • Fax: 214-456-2897
Mailing address:
  • Phone: 214-456-7008
  • Fax: 214-456-2897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05163
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: