Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 17390 | NH |
N | 208600000X | Surgeon | 17390 | NH |
Y | 2086X0206X | Surgical Oncologist | 17390 | NH |
NPI | 1447341904 |
---|---|
Provider Name | Sandra Lynn Wong |
First Address | Lebanon, NH 03756-1000 |
Second Address | Lebanon, NH 03756-1000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 04/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4761460 | (05) | MI |
I43000 | (02) | MI |