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
163W00000X
Registered Nurse
Primary
041.576850
IL
163W00000X
Registered Nurse
773539
NY
163WM1400X
Nurse Massage Therapist (NMT)
Primary
773539
NY
Other
Enumeration date
09/10/2025
Last updated
06/07/2026
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