Provider Demographics
NPI:1073341327
Name:WONG, MEGAN NICOLE
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:NICOLE
Last Name:WONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 EASTCHESTER CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6122
Mailing Address - Country:US
Mailing Address - Phone:614-772-0433
Mailing Address - Fax:
Practice Address - Street 1:314 EASTCHESTER CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-6122
Practice Address - Country:US
Practice Address - Phone:614-772-0433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program