Provider Demographics
NPI:1881003861
Name:SAYAOVANG, MAISEE M (FNP)
Entity Type:Individual
Prefix:
First Name:MAISEE
Middle Name:M
Last Name:SAYAOVANG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 W VILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-4901
Mailing Address - Country:US
Mailing Address - Phone:414-527-8191
Mailing Address - Fax:414-527-8046
Practice Address - Street 1:2400 W VILLARD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-4901
Practice Address - Country:US
Practice Address - Phone:414-527-8191
Practice Address - Fax:414-527-8046
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2013022291363LF0000X
WI6029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1881003861Medicaid