Provider Demographics
NPI:1336878511
Name:VANG, GER
Entity type:Individual
Prefix:
First Name:GER
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 1:911 MARYLAND AVE E STE F5
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55106-2647
Mailing Address - Country:US
Mailing Address - Phone:651-340-3759
Mailing Address - Fax:651-414-9714
Practice Address - Street 1:911 MARYLAND AVE E STE F5
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55106-2647
Practice Address - Country:US
Practice Address - Phone:651-340-3759
Practice Address - Fax:651-414-9714
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN406885251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health