Provider Demographics
NPI:1992864839
Name:WONG, MARY (NP)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2340 CLAY ST
Mailing Address - Street 2:STE 537
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-1932
Mailing Address - Country:US
Mailing Address - Phone:415-600-1099
Mailing Address - Fax:415-600-1097
Practice Address - Street 1:2340 CLAY ST
Practice Address - Street 2:STE 537
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-1932
Practice Address - Country:US
Practice Address - Phone:415-600-1099
Practice Address - Fax:415-600-1097
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CANPF8766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner