Healthcare Provider Details

I. General information

NPI: 1790506467
Provider Name (Legal Business Name): PANG DLIB YANG PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W 9TH AVE
OSHKOSH WI
54904-7247
US

IV. Provider business mailing address

1111 E APPLE CREEK RD
APPLETON WI
54913-8369
US

V. Phone/Fax

Practice location:
  • Phone: 920-223-2000
  • Fax:
Mailing address:
  • Phone: 920-740-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number16082-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16082-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: