Provider Demographics
NPI:1649838889
Name:VANG, EVERETT
Entity type:Individual
Prefix:
First Name:EVERETT
Middle Name:
Last Name:VANG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4006 E LEONARD RD
Mailing Address - Street 2:
Mailing Address - City:DEFOREST
Mailing Address - State:WI
Mailing Address - Zip Code:53532-2636
Mailing Address - Country:US
Mailing Address - Phone:651-276-4120
Mailing Address - Fax:
Practice Address - Street 1:4006 E LEONARD RD
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-2636
Practice Address - Country:US
Practice Address - Phone:651-276-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management