Provider Demographics
NPI:1932455565
Name:WONG, JANET M (MSN)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:M
Last Name:WONG
Suffix:
Gender:F
Credentials:MSN
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7500 CENTRAL AVE
Mailing Address - Street 2:SUITE 208, PHYSICIANS OFFICE BUILDING
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19111-2430
Mailing Address - Country:US
Mailing Address - Phone:215-728-4866
Mailing Address - Fax:215-728-3764
Practice Address - Street 1:7500 CENTRAL AVE
Practice Address - Street 2:SUITE 208, PHYSICIANS OFFICE BUILDING
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2430
Practice Address - Country:US
Practice Address - Phone:215-728-4866
Practice Address - Fax:215-728-3764
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAUP006500C363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health