Healthcare Provider Details

I. General information

NPI: 1669393716
Provider Name (Legal Business Name): ALEXIS WONG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 E SUPERIOR ST
CHICAGO IL
60611-2911
US

IV. Provider business mailing address

155 E SUPERIOR ST
CHICAGO IL
60611-2911
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-6891
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number041.481810
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: