Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 2744033 | WI |
NPI | 1003896093 |
---|---|
Provider Name | Xing Kong |
First Address | Oshkosh, WI 54904-7668 |
Second Address | Oshkosh, WI 54904-7668 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 02/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
41276700 | (05) | WI |