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Individual

PATRICIA AIE-LAN WONG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
FNP-BC, RN

Contact information

Practice address
1200 CENTRE ST, ROSLINDALE, MA 02131-1000
(617) 363-8010
(617) 363-8929
Mailing address
1200 CENTRE ST, ROSLINDALE, MA 02131-1000
(617) 363-8010
(617) 363-8929

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
RN2264036
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
S400132099
MEDICARE
Enumeration date
10/17/2012
Last updated
07/14/2015
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