Individual
KONG HER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3305 S 20TH ST, MILWAUKEE, WI 53215-4940
(414) 645-1984
Mailing address
3305 S 20TH ST, MILWAUKEE, WI 53215-4940
(414) 645-1984
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2740
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720394463
—
WI
Enumeration date
08/19/2010
Last updated
11/23/2021
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