Individual
MRS. LYANNE STEPHANIE WONSANG-BASURTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2247 128TH ST FL 2, COLLEGE POINT, NY 11356-2721
(347) 617-5695
Mailing address
2247 128TH ST FL 2, COLLEGE POINT, NY 11356-2721
Taxonomy
Speciality
Code
Description
License number
State
163WM1400X
Nurse Massage Therapist (NMT)
Primary
773539
NY
Other
Enumeration date
09/10/2025
Last updated
09/10/2025
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