Provider Demographics
NPI:1497187504
Name:VANG, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
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 1:5730 PACKARD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-7117
Mailing Address - Country:US
Mailing Address - Phone:530-749-6866
Mailing Address - Fax:530-749-6397
Practice Address - Street 1:5730 PACKARD AVE STE 100
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7117
Practice Address - Country:US
Practice Address - Phone:530-749-6866
Practice Address - Fax:530-749-6397
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722645163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management