Provider Demographics
NPI:1306143565
Name:WONG, TALIA YVONNIA (LPN)
Entity type:Individual
Prefix:
First Name:TALIA
Middle Name:YVONNIA
Last Name:WONG
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22115 HEMPSTEAD AVE
Mailing Address - Street 2:APT 1F
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11429-2160
Mailing Address - Country:US
Mailing Address - Phone:718-406-7085
Mailing Address - Fax:
Practice Address - Street 1:22115 HEMPSTEAD AVE
Practice Address - Street 2:APT 1F
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11429-2160
Practice Address - Country:US
Practice Address - Phone:718-406-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304474164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY304474OtherLPN LICENSE