Healthcare Provider Details

I. General information

NPI: 1740393420
Provider Name (Legal Business Name): HENGMO YON MCCALL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HHC 18TH MEDCOM
APO AP
96205
KR

IV. Provider business mailing address

HHC 18TH MEDCOM BOX 303
APO AP
96205
KR

V. Phone/Fax

Practice location:
  • Phone: 01182279155128
  • Fax:
Mailing address:
  • Phone: 443-451-1889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN00116197
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: