Individual
CAROLYN WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4064 SIDLEHILL DR, OLIVE BRANCH, MS 38654-6146
(601) 842-9006
Mailing address
4064 SIDLEHILL DRIVE, OLIVE BRANCH, MS 38654
(601) 842-9006
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
18194
TN
363LN0000X
Neonatal Nurse Practitioner
R883470
MS
Other
Enumeration date
02/05/2014
Last updated
03/12/2014
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