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NPI Code Detail

MEDICARE: PATRICIA AIE-LAN WONG FNP-BC, RN

MEDICARE: PATRICIA AIE-LAN WONG FNP-BC, RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LA2200XAdult Health Nurse PractitionerRN2264036MA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1S400132099OTHERMEDICARE

General Provider Information

NPI Number : 1205189032
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA AIE-LAN WONG FNP-BC, RN
Provider Business Mailing Address
First Line : 1200 CENTRE ST
Second Line :
City : ROSLINDALE
State : MA
Zip : 02131-1000
Country : US
Telephone Number : 617-363-8010
Fax Number : 617-363-8929
Provider Business Practice Location Address
First Line : 1200 CENTRE ST
Second Line :
City : ROSLINDALE
State : MA
Zip : 02131-1000
Country : US
Telephone Number : 617-363-8010
Fax Number : 617-363-8929
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2012
Last Update Date : 07/14/2015

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