Healthcare Provider Details

I. General information

NPI: 1316997653
Provider Name (Legal Business Name): ISABELLA SUET WONG NP/PA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5342 DUDLEY BLVD
MCCLELLAN CA
95652-1012
US

IV. Provider business mailing address

10 GREEN MIST CT
SACRAMENTO CA
95831-3834
US

V. Phone/Fax

Practice location:
  • Phone: 916-561-7485
  • Fax: 916-561-7486
Mailing address:
  • Phone: 916-395-6270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14529
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN276898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: