Provider Demographics
NPI:1245764588
Name:VUE, PANG
Entity Type:Individual
Prefix:
First Name:PANG
Middle Name:
Last Name:VUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PANG
Other - Middle Name:
Other - Last Name:YANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12714 W HAMPTON AVE
Mailing Address - Street 2:STE E
Mailing Address - City:BUTLER
Mailing Address - State:WI
Mailing Address - Zip Code:53007-1640
Mailing Address - Country:US
Mailing Address - Phone:262-505-6104
Mailing Address - Fax:262-794-3628
Practice Address - Street 1:12714 W HAMPTON AVE
Practice Address - Street 2:STE E
Practice Address - City:BUTLER
Practice Address - State:WI
Practice Address - Zip Code:53007-1640
Practice Address - Country:US
Practice Address - Phone:262-505-6104
Practice Address - Fax:262-794-3628
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant