Healthcare Provider Details

I. General information

NPI: 1285157354
Provider Name (Legal Business Name): DUACHY VANG APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 N MARTIN LUTHER KING DR
MILWAUKEE WI
53212
US

IV. Provider business mailing address

2555 N MARTIN LUTHER KING DR
MILWAUKEE WI
53212-2709
US

V. Phone/Fax

Practice location:
  • Phone: 414-760-3900
  • Fax: 414-464-6076
Mailing address:
  • Phone: 414-760-3900
  • Fax: 414-464-6076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7807
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number145653
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number145653-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: