Provider Demographics
NPI:1881384006
Name:WONG, LINDSEY (FNP-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 EXCHANGE ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3366
Mailing Address - Country:US
Mailing Address - Phone:503-325-0333
Mailing Address - Fax:503-325-6333
Practice Address - Street 1:2120 EXCHANGE ST STE 111
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3366
Practice Address - Country:US
Practice Address - Phone:503-325-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-10
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10026153363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner