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NPI Code Detail

MEDICARE: KELLY WONG MSN, FNP-BC

MEDICARE: KELLY WONG MSN, 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
1363LF0000XFamily Nurse PractitionerSP009541PA

General Provider Information

NPI Number : 1710157318
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY WONG MSN, FNP-BC
Provider Business Mailing Address
First Line : 4201 HENRY AVE
Second Line : PHILADELPHIA UNIVERSITY, STUDENT HEALTH CENTER
City : PHILADELPHIA
State : PA
Zip : 19144-5409
Country : US
Telephone Number : 215-951-2986
Fax Number : 215-951-6867
Provider Business Practice Location Address
First Line : 4201 HENRY AVE
Second Line : PHILADELPHIA UNIVERSITY, STUDENT HEALTH CENTER
City : PHILADELPHIA
State : PA
Zip : 19144-5409
Country : US
Telephone Number : 215-951-2986
Fax Number : 215-951-6867
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/11/2008
Last Update Date : 01/07/2013

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