Healthcare Provider Details

I. General information

NPI: 1104197375
Provider Name (Legal Business Name): KAREN SMITH WONG CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2012
Last Update Date: 01/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW CHILDREN'S HEALTH CENTER
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

805 N HOWARD ST APT. 231
ALEXANDRIA VA
22304-5466
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-2123
  • Fax:
Mailing address:
  • Phone: 510-691-9538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN1019847
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: