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General NPI Number Information
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NPI Number | 1275107351
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Entity Type | Individual
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Provider Name | KIMBERLIE WANG FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/13/2021
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 1305 N MARTIN AVE
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City | TUCSON
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State | AZ
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Zip | 85721-0001
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Country | US
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Telephone | 520-626-6154
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Fax |
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Provider Business Mailing Address
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Address Line | 10771 CANARY BLOSSOM AVE
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City | LAS VEGAS
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State | NV
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Zip | 89129-3341
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Country | US
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Telephone | 623-698-4790
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 838284
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License Number State | NV
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