Provider Demographics
NPI:1154728152
Name:WONG, PATRICIA (MAC, DIPL AC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:MAC, DIPL AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3016 CHEYENNE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3066
Mailing Address - Country:US
Mailing Address - Phone:907-240-3966
Mailing Address - Fax:
Practice Address - Street 1:3016 CHEYENNE CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3066
Practice Address - Country:US
Practice Address - Phone:907-240-3966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK92171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist