Individual
CHANTHORN VU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5300 MEMORIAL DR, TWO RIVERS, WI 54241-3923
(920) 793-7420
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
168310-30
WI
363L00000X
Nurse Practitioner
10482-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10482-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100134128
—
WI
05
—
100181709
—
WI
Enumeration date
09/12/2012
Last updated
01/25/2024
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