Provider Demographics
NPI:1336692474
Name:VANG, SOPHIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIE
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10072 MOSAIC WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757-5959
Mailing Address - Country:US
Mailing Address - Phone:916-601-1090
Mailing Address - Fax:
Practice Address - Street 1:10072 MOSAIC WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95757-5959
Practice Address - Country:US
Practice Address - Phone:916-601-1090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95004446363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily