MEDICARE: SOUA VANG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	2475771	MN

General Provider Information

NPI Number	:	1346893997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOUA VANG

Provider Business Mailing Address
First Line	:	1358 7TH ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-4104
Country	:	US
Telephone Number	:	651-778-0562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1358 7TH ST E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55106-4104
Country	:	US
Telephone Number	:	651-778-0562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	07/23/2019

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Directions to “ SOUA VANG ” Practice Location

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