MEDICARE: ZOUALIA VANG DNP, APNP, NP-C

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	363L00000X	Nurse Practitioner	12219	MN

General Provider Information

NPI Number	:	1912618190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZOUALIA VANG DNP, APNP, NP-C

Provider Business Mailing Address
First Line	:	3760 HAZEL TRL UNIT A
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55129-8773
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11115 12TH ST N
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-9600
Country	:	US
Telephone Number	:	920-374-9126
Fax Number	:

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

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	04/10/2026

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