Healthcare Provider Details

I. General information

NPI: 1912819202
Provider Name (Legal Business Name): VANESSA PANG RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 SE MAYNARD RD STE 201
CARY NC
27511-6945
US

IV. Provider business mailing address

4208 BUMPHUS RD
CHAPEL HILL NC
27514-9538
US

V. Phone/Fax

Practice location:
  • Phone: 980-428-1500
  • Fax:
Mailing address:
  • Phone: 980-428-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number287073
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-301089
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: