MEDICARE: MS. IRIS C WONG NP

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
1	363LF0000X	Family Nurse Practitioner	233807	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	NP5023	OTHER	MA	BCBS

General Provider Information

NPI Number	:	1306837711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRIS C WONG NP

Provider Business Mailing Address
First Line	:	110 W SQUANTUM ST
Second Line	:
City	:	NORTH QUINCY
State	:	MA
Zip	:	02171-2122
Country	:	US
Telephone Number	:	617-376-3000
Fax Number	:	173-763-0246

Provider Business Practice Location Address
First Line	:	110 W SQUANTUM ST
Second Line	:
City	:	NORTH QUINCY
State	:	MA
Zip	:	02171-2122
Country	:	US
Telephone Number	:	617-376-3000
Fax Number	:	617-376-3024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2005
Last Update Date	:	04/02/2022

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