Individual
JESSICA MAIKOU VANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
715 S 8TH ST, MINNEAPOLIS, MN 55404
(612) 873-6963
Mailing address
715 S 8TH ST, ATTN CSC PEDS CLINIC 3RD FLOOR, MINNEAPOLIS, MN 55404-1210
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
229040-7
MN
363LP0200X
Pediatric Nurse Practitioner
Primary
6454
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/19/2018
Last updated
12/05/2019
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