Healthcare Provider Details

I. General information

NPI: 1619258050
Provider Name (Legal Business Name): QIN WANG ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 COOPER POINT RD SW
OLYMPIA WA
98502-5736
US

IV. Provider business mailing address

1620 COOPER POINT RD SW
OLYMPIA WA
98502-5736
US

V. Phone/Fax

Practice location:
  • Phone: 360-486-6710
  • Fax: 360-705-0269
Mailing address:
  • Phone: 360-486-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61264265
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.12535
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: