Provider Demographics
NPI:1134603574
Name:CHANG, PANG Z (CRNA)
Entity type:Individual
Prefix:
First Name:PANG
Middle Name:Z
Last Name:CHANG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:PANG
Other - Middle Name:Z
Other - Last Name:THAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1456 AMES AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-3517
Mailing Address - Country:US
Mailing Address - Phone:516-239-3188
Mailing Address - Fax:
Practice Address - Street 1:1400 BELLINGER ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-5222
Practice Address - Country:US
Practice Address - Phone:715-838-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11003059367500000X
NY790501367500000X
WI10967367500000X
MNR203501-5367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered