Provider Demographics
NPI:1851967434
Name:VANG, MAI G (NP)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:G
Last Name:VANG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 WATERTOWER PL STE 500
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8053
Mailing Address - Country:US
Mailing Address - Phone:517-333-6060
Mailing Address - Fax:
Practice Address - Street 1:1550 WATERTOWER PL STE 500
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8053
Practice Address - Country:US
Practice Address - Phone:517-333-6060
Practice Address - Fax:517-333-6068
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704314177363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health