Individual
KELLY MARIE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
861 SW 78TH AVE, STE 200B, PLANTATION, FL 33324-3273
(877) 693-5700
Mailing address
6553 E BAYWOOD AVE STE 201, MESA, AZ 85206-1754
(480) 467-2273
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP4100
AZ
Other
Enumeration date
08/29/2011
Last updated
06/20/2023
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