Provider Demographics
NPI:1255597563
Name:LAU, KORRINA WAILONNA WONG (BSN, MSN, RN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:KORRINA
Middle Name:WAILONNA WONG
Last Name:LAU
Suffix:
Gender:F
Credentials:BSN, MSN, RN, FNP-BC
Other - Prefix:MS
Other - First Name:KORRINA
Other - Middle Name:WAILONNA
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, MSN, RN, FNP-BC
Mailing Address - Street 1:1804 EMBARCADERO RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3341
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-498-6000
Practice Address - Fax:650-723-0765
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR169405363LF0000X
CA95001927363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4176111 00Medicaid
MD149404YRFMedicare PIN