Provider Demographics
NPI:1447524491
Name:VONGSAVANH, VATSANA (RN)
Entity type:Individual
Prefix:
First Name:VATSANA
Middle Name:
Last Name:VONGSAVANH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 N GATEWAY BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-1643
Mailing Address - Country:US
Mailing Address - Phone:559-255-9965
Mailing Address - Fax:559-255-2871
Practice Address - Street 1:1951 N GATEWAY BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-1643
Practice Address - Country:US
Practice Address - Phone:559-255-9965
Practice Address - Fax:559-255-2871
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA739967163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health