Individual
DOMONIQUE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6780 MAYFIELD RD, MAYFIELD HTS, OH 44124-2203
(440) 312-4500
Mailing address
6780 MAYFIELD RD, MAYFIELD HTS, OH 44124-2203
(440) 312-4500
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
CNP.019628
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019083
—
OH
Enumeration date
08/19/2016
Last updated
10/23/2019
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