MEDICARE: MAI MOUA VANG NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	8987	MN

General Provider Information

NPI Number	:	1558020578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAI MOUA VANG NP

Provider Business Mailing Address
First Line	:	3500 AMERICAN BLVD W STE 300
Second Line	:
City	:	BLOOMINGTON
State	:	MN
Zip	:	55431-4442
Country	:	US
Telephone Number	:	952-512-5600
Fax Number	:

Provider Business Practice Location Address
First Line	:	470 WATER ST
Second Line	:
City	:	EXCELSIOR
State	:	MN
Zip	:	55331-3089
Country	:	US
Telephone Number	:	952-442-6950
Fax Number	:	952-955-6276

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2021
Last Update Date	:	04/23/2024

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Directions to “ MAI MOUA VANG NP” Practice Location

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