Individual
KATHERINE ELIZABETH WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2085 N 63RD ST, PHILADELPHIA, PA 19151-2675
(215) 452-0304
Mailing address
1408 GERMANTOWN AVENUE, PHILADELPHIA, PA 19122
(917) 620-9396
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
26NJ00730000
NJ
363L00000X
Nurse Practitioner
Primary
SP017222
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1033698760001
—
PA
Enumeration date
06/05/2017
Last updated
04/06/2018
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