Provider Demographics
NPI:1104226380
Name:WANGMO, KALSANG (NP-C)
Entity type:Individual
Prefix:
First Name:KALSANG
Middle Name:
Last Name:WANGMO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 OLD HIGHWAY 8 SW APT 205
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-7729
Mailing Address - Country:US
Mailing Address - Phone:612-280-7074
Mailing Address - Fax:
Practice Address - Street 1:371 OLD HIGHWAY 8 SW APT 205
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-7729
Practice Address - Country:US
Practice Address - Phone:612-280-7074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 163226-0363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner