=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568472637
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YIPING MAGGIE ZENG-WANG FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2006
-----------------------------------------------------
Last Update Date | 01/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3901 BEAUBIEN - 4TH FL CARL'S BLDG CHILDREN'S HOSPITAL OF MI
-----------------------------------------------------
City | DETROIT
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-745-4485
-----------------------------------------------------
Fax | 313-745-5155
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17900 23 MILE RD STE 101
-----------------------------------------------------
City | MACOMB
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48044-1161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 313-745-4405
-----------------------------------------------------
Fax | 313-966-0665
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 4704211485
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 4704211485
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------