Healthcare Provider Details

I. General information

NPI: 1750648325
Provider Name (Legal Business Name): HOUA VANG-IPEMA FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 E HERNDON AVE STE 101
FRESNO CA
93720-3346
US

IV. Provider business mailing address

7369 E MICHIGAN AVE
FRESNO CA
93737-0022
US

V. Phone/Fax

Practice location:
  • Phone: 559-779-2813
  • Fax:
Mailing address:
  • Phone: 559-779-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95039064
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95236121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: