| Doctor Name: | PATRICIA AIE-LAN WONG |
| NPI Number: | 1205189032 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-BC, RN |
| License Number: | RN2264036 |
| Business Practice Address: | 1200 Centre St Roslindale, MA - 021311000 |
| Business Phone Number: | 6173638010 |
| Business Fax Number: | 6173638929 |
| Mailing Address: | 1200 Centre St, ROSLINDALE |
| State: | MA |
| Postal Code: | 021311000 |
| Phone Number: | 6173638010 |
| Fax Number: | 6173638929 |
| NPI Enumeration Date: | 10/17/2012 |
| NPI Last Update Date: | 07/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | RN2264036 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |