Provider Demographics
NPI:1619155694
Name:VANG, PAFOUA
Entity Type:Individual
Prefix:
First Name:PAFOUA
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 1:1399 CURRIE STREET NO
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-3191
Mailing Address - Country:US
Mailing Address - Phone:651-260-6048
Mailing Address - Fax:651-224-1882
Practice Address - Street 1:1399 CURRIE ST N
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-3191
Practice Address - Country:US
Practice Address - Phone:651-260-6048
Practice Address - Fax:651-224-1882
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care