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General NPI Number Information
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NPI Number | 1619251147
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Entity Type | Individual
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Provider Name | GLENNYN WONG LARA RN
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Gender | Female
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Dates
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Enumeration Date | 10/03/2011
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Last Update Date | 01/25/2026
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Provider Practice Location Address
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Address Line | 7100 W 20TH AVE STE 212
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City | HIALEAH
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State | FL
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Zip | 33016-1812
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Country | US
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Telephone | 305-504-2117
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Fax | 305-504-2117
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Provider Business Mailing Address
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Address Line | 4300 NW 173RD DR
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City | MIAMI GARDENS
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State | FL
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Zip | 33055-3706
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Country | US
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Telephone | 786-302-8511
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 9614896
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License Number State | FL
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