Healthcare Provider Details

I. General information

NPI: 1922179084
Provider Name (Legal Business Name): SIEW LIN WONG RN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

IV. Provider business mailing address

7300 N FRESNO ST
FRESNO CA
93720-2941
US

V. Phone/Fax

Practice location:
  • Phone: 559-448-4953
  • Fax: 559-448-4201
Mailing address:
  • Phone: 155-944-8555
  • Fax: 559-448-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN432004
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: