Provider Demographics
NPI:1962232827
Name:VANG, PA KOU (RN)
Entity type:Individual
Prefix:
First Name:PA
Middle Name:KOU
Last Name:VANG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 UNIVERSITY AVE W STE 123B
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103-3901
Mailing Address - Country:US
Mailing Address - Phone:651-641-8660
Mailing Address - Fax:
Practice Address - Street 1:225 UNIVERSITY AVE W STE 123B
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103-3901
Practice Address - Country:US
Practice Address - Phone:651-641-8660
Practice Address - Fax:651-641-8652
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2458998163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health