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General NPI Number Information
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NPI Number | 1154952794
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Entity Type | Individual
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Provider Name | HAIRONG WANG
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Gender | Female
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Dates
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Enumeration Date | 02/02/2020
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Last Update Date | 02/09/2020
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Provider Practice Location Address
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Address Line | 202 QUEEN ST
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City | BRISTOL
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State | CT
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Zip | 06010-5809
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Country | US
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Telephone | 860-261-5752
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Fax |
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Provider Business Mailing Address
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Address Line | 35 W HILLS DR
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City | AVON
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State | CT
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Zip | 06001-2239
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Country | US
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Telephone | 860-803-1917
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 12.008674
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License Number State | CT
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