1568472637 NPI number — YIPING MAGGIE ZENG-WANG FNP

Table of content: YIPING MAGGIE ZENG-WANG FNP (NPI 1568472637)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568472637 NPI number — YIPING MAGGIE ZENG-WANG FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZENG-WANG
Provider First Name:
YIPING
Provider Middle Name:
MAGGIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568472637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17900 23 MILE RD
Provider Second Line Business Mailing Address:
STE 101
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48044-1161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
313-745-4405
Provider Business Mailing Address Fax Number:
313-966-0665

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3901 BEAUBIEN - 4TH FL CARL'S BLDG
Provider Second Line Business Practice Location Address:
CHILDREN'S HOSPITAL OF MI
Provider Business Practice Location Address City Name:
DETROIT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
313-745-4485
Provider Business Practice Location Address Fax Number:
313-745-5155
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  4704211485 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 4704211485 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P00231995 . This is a "RR MEDICARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: YZ211485 . This is a "BLUE SHIELD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 470245010 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 470451610 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com