Healthcare Provider Details

I. General information

NPI: 1750914800
Provider Name (Legal Business Name): LOYETTE WONG FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MILL CREEK PKWY STE 202
CHESAPEAKE VA
23323-1278
US

IV. Provider business mailing address

822 OLMSTEAD ST
CHESAPEAKE VA
23323-1451
US

V. Phone/Fax

Practice location:
  • Phone: 347-768-5483
  • Fax:
Mailing address:
  • Phone: 347-768-5483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178877
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178877
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: