Provider Demographics
NPI:1508431511
Name:ELITA WONG, PSYCHIATRIC NURSE PRACTITIONER PLLC
Entity Type:Organization
Organization Name:ELITA WONG, PSYCHIATRIC NURSE PRACTITIONER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PSYCHIATRIC NP
Authorized Official - Prefix:
Authorized Official - First Name:ELITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:206-531-7844
Mailing Address - Street 1:223 BEDFORD AVE NO. 888
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211
Mailing Address - Country:US
Mailing Address - Phone:206-531-7844
Mailing Address - Fax:503-386-3252
Practice Address - Street 1:223 BEDFORD AVE NO. 888
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211
Practice Address - Country:US
Practice Address - Phone:206-531-7844
Practice Address - Fax:503-386-3252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, AdultGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202008233NP-PPOtherOREGON STATE BOARD OF NURSING
WAAP61085917OtherWASHINGTON STATE BOARD OF NURSING