Individual
VANG MOUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5950 N 74TH ST, MILWAUKEE, WI 53218-1830
(414) 374-2520
Mailing address
5950 N 74TH ST, MILWAUKEE, WI 53218-1830
(414) 374-2520
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
M0008638320601
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
M0008638320601
DRIVER'S LICENSE
WI
Enumeration date
03/29/2019
Last updated
03/29/2019
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