Provider Demographics
NPI:1235366410
Name:WONG, FOWN OY
Entity Type:Individual
Prefix:
First Name:FOWN
Middle Name:OY
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 NORTH PORTAGE PATH
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303
Mailing Address - Country:US
Mailing Address - Phone:330-869-4918
Mailing Address - Fax:330-869-4918
Practice Address - Street 1:275 NORTH PORTAGE PATH
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303
Practice Address - Country:US
Practice Address - Phone:330-869-4918
Practice Address - Fax:330-869-4918
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 294453163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSA229455OtherOHIO DRIVER LICENSE