Healthcare Provider Details

I. General information

NPI: 1255123576
Provider Name (Legal Business Name): LANA VANG APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 GRAND SEASONS DR
WAUPACA WI
54981-8219
US

IV. Provider business mailing address

PO BOX 131
COMBINED LOCKS WI
54113-0131
US

V. Phone/Fax

Practice location:
  • Phone: 715-258-3650
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number16102-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number224558
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: