MEDICARE: ELISE MEGAN WONG ND, LAC

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	171100000X	Acupuncturist	AC61483050	WA
2	175F00000X	Naturopath	NT60901094	WA

General Provider Information

NPI Number	:	1427329457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISE MEGAN WONG ND, LAC

Provider Business Mailing Address
First Line	:	1217 4TH AVE E STE 101
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4246
Country	:	US
Telephone Number	:	360-972-0316
Fax Number	:	360-338-3712

Provider Business Practice Location Address
First Line	:	1217 4TH AVE E STE 101
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98506-4246
Country	:	US
Telephone Number	:	360-972-0316
Fax Number	:	360-338-3712

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

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	04/14/2026

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