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General NPI Number Information
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NPI Number | 1003475278
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Entity Type | Individual
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Provider Name | MILAGROS AREL WONG
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 199 PARK ROAD EXT
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City | MIDDLEBURY
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State | CT
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Zip | 06762-1833
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Country | US
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Telephone | 203-437-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 81 MAYFIELD RD
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City | WATERBURY
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State | CT
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Zip | 06708-3236
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Country | US
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Telephone | 475-235-4697
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 8219
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License Number State | CT
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