Provider Demographics
NPI:1609411289
Name:WANG, CHONG (RN, BSN, OCN)
Entity Type:Individual
Prefix:
First Name:CHONG
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:RN, BSN, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 LAKELAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4699
Mailing Address - Country:US
Mailing Address - Phone:601-863-9399
Mailing Address - Fax:
Practice Address - Street 1:969 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4699
Practice Address - Country:US
Practice Address - Phone:018-639-3996
Practice Address - Fax:601-200-6625
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS889018163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0200XNursing Service ProvidersRegistered NurseOncology