Provider Demographics
NPI:1396183968
Name:WONG, MICHAL ELIZABETH ANNE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:ELIZABETH ANNE
Last Name:WONG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10322 ECLIPSE CT
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6320
Mailing Address - Country:US
Mailing Address - Phone:714-539-4322
Mailing Address - Fax:
Practice Address - Street 1:10322 ECLIPSE CT
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-6320
Practice Address - Country:US
Practice Address - Phone:714-539-4322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP21679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily