1750713525 NPI number — MR. DANNY JOE VANCE M.S., L.P.C.C.

Table of content: MR. DANNY JOE VANCE M.S., L.P.C.C. (NPI 1750713525)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750713525 NPI number — MR. DANNY JOE VANCE M.S., L.P.C.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCE
Provider First Name:
DANNY
Provider Middle Name:
JOE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.S., L.P.C.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750713525
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
102 GRANNIS ST
Provider Second Line Business Mailing Address:
PO BOX 154
Provider Business Mailing Address City Name:
VERNON CENTER
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56090-1127
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-726-6550
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 EAST STREET SOUTH
Provider Second Line Business Practice Location Address:
PO BOX 154
Provider Business Practice Location Address City Name:
VERNON CENTER
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-549-3636
Provider Business Practice Location Address Fax Number:
507-549-3636
Provider Enumeration Date:
08/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  958 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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