Provider Demographics
NPI:1770916496
Name:WONG, INNA K (RN)
Entity type:Individual
Prefix:
First Name:INNA
Middle Name:K
Last Name:WONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 DE CRISANTO PL
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-4353
Mailing Address - Country:US
Mailing Address - Phone:916-956-4545
Mailing Address - Fax:916-684-8181
Practice Address - Street 1:6331 DE CRISANTO PL
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-4353
Practice Address - Country:US
Practice Address - Phone:916-956-4545
Practice Address - Fax:916-684-8181
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-16
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA781040163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse