Individual
MRS. PA KOU VANG THAO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
508 W WISCONSIN AVE, APPLETON, WI 54911-4337
(920) 731-6304
Mailing address
315 BIRCH ST, HORTONVILLE, WI 54944-9355
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
7641-33
WI
Other
Enumeration date
06/05/2017
Last updated
06/05/2017
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