Individual
SHIRLEY WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSN, RN, PHN
Contact information
Practice address
1060 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4339
Mailing address
1060 EMELINE AVE, SANTA CRUZ, CA 95060-1966
(831) 454-4339
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
95086409
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70042F CA FQHC
70042F CA FQHC
CA
Enumeration date
05/16/2017
Last updated
05/16/2017
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