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General NPI Number Information
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NPI Number | 1043290703
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Entity Type | Individual
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Provider Name | SO-FONG WONG FNP, CNS, CDE
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Gender | Female
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Dates
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Enumeration Date | 01/19/2006
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 5050 CRENSHAW RD STE 100
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City | PASADENA
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State | TX
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Zip | 77505-3138
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Country | US
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Telephone | 281-487-1000
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Fax | 832-399-4110
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Provider Business Mailing Address
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Address Line | 5050 CRENSHAW RD STE 100
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City | PASADENA
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State | TX
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Zip | 77505-3138
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Country | US
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Telephone | 281-487-1000
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Fax | 832-399-4110
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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 | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number | 21210407
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | AP110586
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP110586
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 654824
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 364SA2200X
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Taxonomy Name | Adult Health Clinical Nurse Specialist
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License Number | 654824
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License Number State | TX
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