Provider Demographics
NPI:1447749643
Name:WONG, JENNIFER AQUINO (BSN, CNOR, RNFA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:AQUINO
Last Name:WONG
Suffix:
Gender:F
Credentials:BSN, CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3418 WOODBINE PL
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4863
Mailing Address - Country:US
Mailing Address - Phone:832-646-3240
Mailing Address - Fax:
Practice Address - Street 1:3418 WOODBINE PL
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4863
Practice Address - Country:US
Practice Address - Phone:832-646-3240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX676313163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Multi-Specialty