Individual
BAO VANG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1340 S 25TH ST, MANITOWOC, WI 54220-5525
(920) 242-8465
Mailing address
1340 S 25TH ST, MANITOWOC, WI 54220-5525
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/20/2023
Last updated
06/20/2023
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