MEDICARE: MS. LYANN WONG FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	F35764401	NY
2	363LP2300X	Primary Care Nurse Practitioner	F35764401	NY

General Provider Information

NPI Number	:	1376420067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LYANN WONG FNP-BC

Provider Business Mailing Address
First Line	:	2121 I ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20052-0086
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 I ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20052-0086
Country	:	US
Telephone Number	:	202-994-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	09/11/2025

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