Healthcare Provider Details

I. General information

NPI: 1619155694
Provider Name (Legal Business Name): PAFOUA VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 CURRIE ST N
MAPLEWOOD MN
55119-3191
US

IV. Provider business mailing address

1399 CURRIE STREET NO
MAPLEWOOD MN
55119-3191
US

V. Phone/Fax

Practice location:
  • Phone: 651-260-6048
  • Fax: 651-224-1882
Mailing address:
  • Phone: 651-260-6048
  • Fax: 651-224-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: