Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 431290 | NY |
NPI | 1043670912 |
---|---|
Provider Name | Rachel Shelby Wong |
First Address | New York, NY 10026-3273 |
Second Address | New York, NY 10032-3720 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2016 |
Last Update Date | 23/07/2018 |