Individual
MARISA WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2710 PROSPERITY AVE STE 200, FAIRFAX, VA 22031-4358
(703) 280-2841
Mailing address
8525 TYSONS CT, VIENNA, VA 22182-5019
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024177055
VA
Other
Enumeration date
07/26/2022
Last updated
08/10/2022
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