Basic Information
| Provider Information | |||||||||
| NPI: | 1073258513 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VANG | ||||||||
| FirstName: | JULIA | ||||||||
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| Credential: | APRN-CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 N STONEWALL AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731171200 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1601 S BOULEVARD STE 108 | ||||||||
| Address2: | |||||||||
| City: | EDMOND | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730135143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4053489904 | ||||||||
| FaxNumber: | 8334701448 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2022 | ||||||||
| LastUpdateDate: | 09/14/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 204746 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 363LF0000X | 204746 | OK | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.