Provider Demographics
NPI:1720369515
Name:VANG, DOUACHI (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:DOUACHI
Middle Name:
Last Name:VANG
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9155 16TH ST N
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-9313
Mailing Address - Country:US
Mailing Address - Phone:651-492-0322
Mailing Address - Fax:
Practice Address - Street 1:569 DALE ST N STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-1917
Practice Address - Country:US
Practice Address - Phone:651-488-3126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 199419-9163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health