Provider Demographics
NPI:1083255335
Name:WONG, BRANDON (RN)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 FEATHERS NEST WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-9606
Mailing Address - Country:US
Mailing Address - Phone:510-330-7056
Mailing Address - Fax:
Practice Address - Street 1:8012 FEATHERS NEST WAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95829-9606
Practice Address - Country:US
Practice Address - Phone:510-330-7056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95159488163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse