Healthcare Provider Details

I. General information

NPI: 1194863050
Provider Name (Legal Business Name): NAINA WASAN P.A.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W MAIN ST
LEWISVILLE TX
75057-3629
US

IV. Provider business mailing address

PO BOX 201606
DALLAS TX
75320-1606
US

V. Phone/Fax

Practice location:
  • Phone: 972-420-1576
  • Fax: 972-420-1850
Mailing address:
  • Phone: 972-758-3598
  • Fax: 972-599-9604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04819
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA04619
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: