Healthcare Provider Details

I. General information

NPI: 1306518295
Provider Name (Legal Business Name): CHOUA YANG VANG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 W CAPITOL DR
MILWAUKEE WI
53222-1338
US

IV. Provider business mailing address

2000 E LAYTON AVE
ST FRANCIS WI
53235-6053
US

V. Phone/Fax

Practice location:
  • Phone: 414-810-4844
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11308-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: