| Doctor Name: | CAROLYN WONG |
| NPI Number: | 1023432549 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | R883470 |
| Business Practice Address: | 4064 Sidlehill Dr Olive Branch, MS - 386546146 |
| Business Phone Number: | 6018429006 |
| Business Fax Number: | |
| Mailing Address: | 4064 Sidlehill Drive, OLIVE BRANCH |
| State: | MS |
| Postal Code: | 38654 |
| Phone Number: | 6018429006 |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2014 |
| NPI Last Update Date: | 03/12/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LN0000X |
| License Number: | R883470 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Neonatal |
| Taxonomy Definition: | |