Provider Demographics
NPI:1659032795
Name:VANG, PAO DOUA (DNP, APNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:PAO
Middle Name:DOUA
Last Name:VANG
Suffix:
Gender:F
Credentials:DNP, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13444 JONQUIL ST NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3854
Mailing Address - Country:US
Mailing Address - Phone:608-385-4000
Mailing Address - Fax:
Practice Address - Street 1:1110 HENNEPIN AVE # 6040
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-1704
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily