Provider Demographics
NPI:1326257999
Name:VANG, SUZY YANG
Entity Type:Individual
Prefix:
First Name:SUZY
Middle Name:YANG
Last Name:VANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23592 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-8673
Mailing Address - Country:US
Mailing Address - Phone:763-428-0653
Mailing Address - Fax:
Practice Address - Street 1:23592 BIRCH RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-8673
Practice Address - Country:US
Practice Address - Phone:763-428-0653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant