Provider Demographics
NPI:1508541624
Name:WONGANYA, JANELLE M
Entity Type:Individual
Prefix:MS
First Name:JANELLE
Middle Name:M
Last Name:WONGANYA
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 1:908 MONTICELLO DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-8208
Mailing Address - Country:US
Mailing Address - Phone:682-438-1329
Mailing Address - Fax:
Practice Address - Street 1:908 MONTICELLO DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-8208
Practice Address - Country:US
Practice Address - Phone:682-438-1329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver