Active NPI
Domonique Wong
- Family Nurse Practitioner
- Mayfield HTS, OH
National Provider Identifier
1497200455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- CNP.019628
- Practice address
- 6780 Mayfield Rd
Mayfield HTS, OH 44124-2203 - Phone
- (440) 312-4500
- NPI assigned
- Aug 19, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | CNP.019628 | OH | Primary |
Addresses
Primary practice location
6780 Mayfield Rd
Mayfield HTS, OH 44124-2203
Mailing address
6780 Mayfield Rd
Mayfield HTS, OH 44124-2203
Phone (440) 312-4500
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 019083 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CNP.019628 | OH | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571788800000",
"number": "1497200455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6780 MAYFIELD RD",
"city": "MAYFIELD HTS",
"state": "OH",
"postal_code": "441242203",
"telephone_number": "440-312-4500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6780 MAYFIELD RD",
"city": "MAYFIELD HTS",
"state": "OH",
"postal_code": "441242203",
"telephone_number": "440-312-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "DOMONIQUE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-08-19",
"last_updated": "2019-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "OH",
"license": "CNP.019628",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019083",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mayfield HTS, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.