Provider Demographics
NPI:1477528073
Name:ONG, PAULETTE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:
Last Name:ONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E 54TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-7214
Mailing Address - Country:US
Mailing Address - Phone:563-323-1229
Mailing Address - Fax:563-323-8240
Practice Address - Street 1:1801 E 54TH ST
Practice Address - Street 2:STE 100
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-7209
Practice Address - Country:US
Practice Address - Phone:563-323-1229
Practice Address - Fax:563-323-8240
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001272363AM0700X
IL085001740363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA970024406OtherRAILROAD MEDICARE
IL970024407OtherRAILROAD MEDICARE
IAP46697Medicare UPIN
IAI4435Medicare ID - Type Unspecified
IL200367Medicare ID - Type Unspecified