MEDICARE: CHRISTINA KALEIMOMI LEE WONG APRN

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	363LF0000X	Family Nurse Practitioner	APRN 1061	HI

General Provider Information

NPI Number	:	1558549774
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA KALEIMOMI LEE WONG APRN

Provider Business Mailing Address
First Line	:	4211 WAIALAE AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5319
Country	:	US
Telephone Number	:	808-732-0782
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 WAIALAE AVE
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5319
Country	:	US
Telephone Number	:	808-732-0782
Fax Number	:

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	07/21/2022

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