Provider Demographics
NPI:1225629421
Name:VANG, PAAHOUA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:PAAHOUA
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 PAYNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55130-3667
Mailing Address - Country:US
Mailing Address - Phone:651-209-8350
Mailing Address - Fax:651-209-8353
Practice Address - Street 1:1239 PAYNE AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-3667
Practice Address - Country:US
Practice Address - Phone:651-209-8350
Practice Address - Fax:651-209-8353
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily