Individual provider Active NPI

Pang Vang, DNP, APRN, CNP

  • Family Nurse Practitioner
  • Minneapolis, MN
National Provider Identifier
1073265328
Registry record updated Apr 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
F12210545 Issued in MN
Practice address
525 Portland Ave. FL 4 Mc952
Minneapolis, MN 55415-1533
Phone
(612) 543-5555
NPI assigned
Jan 18, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X F12210545 MN Primary

Addresses

Primary practice location

525 Portland Ave. FL 4 Mc952
Minneapolis, MN 55415-1533

Mailing address

525 Portland Ave. FL 4 Mc952
Minneapolis, MN 55415-1533
Phone (612) 543-5555

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL malwarebytes

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220629001728 MN Practitioner - Nurse Practitioner 4880074426 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

525 Portland Ave S MC
Suite 952
Minneapolis, MN 55415-1569
Phone (612) 543-5555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F12210545MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Gillette Children'S Specialty Healthcare CurrentSince May 16, 2022 Accepting new patients
Gillette Children'S Specialty Healthcare CurrentSince May 16, 2022 Accepting new patients
Hennepin County CurrentSince Jun 3, 2024 Accepting new patients
Hennepin County Current Accepting new patients
Hennepin County CurrentSince Jun 3, 2024 Accepting new patients
Hennepin County PastSince Apr 21, 2024 Accepting new patients

Locations

525 Portland Ave
Fl 4
Minneapolis, MN 55415
Phone (612) 348-9840

9600 Aldrich Ave S
#658
Minneapolis, MN 55420

525 Portland Ave
Minneapolis, MN 55415
Phone (612) 348-8824

435 Phalen Blvd
Saint Paul, MN 55130
Phone (651) 254-3200

200 University Ave E
Saint Paul, MN 55101
Phone (651) 291-2848

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1642464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713484800000",
    "number": "1073265328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE. FL 4 MC952",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-543-5555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 PORTLAND AVE. FL 4 MC952",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151533",
            "telephone_number": "612-543-5555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANG",
        "first_name": "PANG",
        "credential": "DNP, APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-01-18",
        "last_updated": "2024-04-19",
        "certification_date": "2024-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "F12210545",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "malwarebytes",
            "affiliation": "N",
            "address_1": "525 Portland Ave. Fl 4 MC952",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554151533",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.