Healthcare Provider Details

I. General information

NPI: 1215230842
Provider Name (Legal Business Name): DEBBIE WONG CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2010
Last Update Date: 11/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 DOUGLAS AVE
CHARLOTTESVILLE VA
22902-5748
US

IV. Provider business mailing address

1205 RUGBY RD
CHARLOTTESVILLE VA
22903-1236
US

V. Phone/Fax

Practice location:
  • Phone: 434-987-1257
  • Fax:
Mailing address:
  • Phone: 434-987-1257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0129000063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: