Provider Demographics
NPI:1093253593
Name:VANG, DAO NHIATOU (FNP)
Entity Type:Individual
Prefix:
First Name:DAO
Middle Name:NHIATOU
Last Name:VANG
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:608 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6855
Mailing Address - Country:US
Mailing Address - Phone:704-293-6601
Mailing Address - Fax:
Practice Address - Street 1:608 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6855
Practice Address - Country:US
Practice Address - Phone:704-293-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily