Provider Demographics
NPI:1699345397
Name:WING, DENISE MONICA (LPN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MONICA
Last Name:WING
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 1:395 CENTRAL ISLIP BLVD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3908
Mailing Address - Country:US
Mailing Address - Phone:631-379-8249
Mailing Address - Fax:
Practice Address - Street 1:395 CENTRAL ISLIP BLVD
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3908
Practice Address - Country:US
Practice Address - Phone:631-379-8249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338784-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse