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General NPI Number Information
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NPI Number | 1831622513
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Entity Type | Individual
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Provider Name | PAJ NTAUB VANG MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2017
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 2005 MIDWAY RD
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City | MENASHA
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State | WI
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Zip | 54952-7002
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Country | US
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Telephone | 920-832-8500
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Fax |
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Provider Business Mailing Address
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Address Line | 3 NEENAH CTR
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City | NEENAH
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State | WI
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Zip | 54956-3070
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Country | US
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Telephone | 920-832-8500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 71037-20
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License Number State | WI
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