Healthcare Provider Details

I. General information

NPI: 1740948637
Provider Name (Legal Business Name): MICHELLE NOU VANG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 E STOCKTON BLVD
ELK GROVE CA
95624-1563
US

IV. Provider business mailing address

9340 E STOCKTON BLVD
ELK GROVE CA
95624-1563
US

V. Phone/Fax

Practice location:
  • Phone: 916-509-8198
  • Fax:
Mailing address:
  • Phone: 916-509-8198
  • Fax: 916-509-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: