Healthcare Provider Details

I. General information

NPI: 1073258513
Provider Name (Legal Business Name): JULIA VANG APRN-CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2022
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 S BOULEVARD STE 108
EDMOND OK
73013-5143
US

IV. Provider business mailing address

1100 N STONEWALL AVE
OKLAHOMA CITY OK
73117-1200
US

V. Phone/Fax

Practice location:
  • Phone: 405-348-9904
  • Fax: 833-470-1448
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number204746
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204746
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: