Provider Demographics
NPI:1619408192
Name:PANYANOUVONG, VANNASINH
Entity Type:Individual
Prefix:
First Name:VANNASINH
Middle Name:
Last Name:PANYANOUVONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 YOUNG OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-3205
Mailing Address - Country:US
Mailing Address - Phone:337-256-0221
Mailing Address - Fax:
Practice Address - Street 1:107 YOUNG OAK DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-3205
Practice Address - Country:US
Practice Address - Phone:337-256-0221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-25
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09443367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered