Provider Demographics
NPI:1689321044
Name:TANG, MAUREEN L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:L
Last Name:TANG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10722
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-0722
Mailing Address - Country:US
Mailing Address - Phone:671-689-8264
Mailing Address - Fax:
Practice Address - Street 1:520 W SANTA MONICA AVE
Practice Address - Street 2:
Practice Address - City:DEDEDO
Practice Address - State:GU
Practice Address - Zip Code:96929-5286
Practice Address - Country:US
Practice Address - Phone:671-635-7400
Practice Address - Fax:671-635-4413
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUNP0244363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily