Provider Demographics
NPI:1699012914
Name:WONG, MELINDA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:
Other - Last Name:WEAVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1406 MCGAVOCK PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37216-3233
Mailing Address - Country:US
Mailing Address - Phone:615-732-1030
Mailing Address - Fax:
Practice Address - Street 1:1406 MCGAVOCK PIKE STE B
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37216-3233
Practice Address - Country:US
Practice Address - Phone:615-732-1030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily