1770781841 NPI number — MRS. VIOLET R VANCE ARNP

Table of content: MRS. VIOLET R VANCE ARNP (NPI 1770781841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770781841 NPI number — MRS. VIOLET R VANCE ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VANCE
Provider First Name:
VIOLET
Provider Middle Name:
R
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

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:
1770781841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 70 BOX 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENORE
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25676-9702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-475-3834
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH WILLIAMSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41503-4095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-237-4943
Provider Business Practice Location Address Fax Number:
606-237-1797
Provider Enumeration Date:
07/10/2007

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: 363LF0000X , with the licence number:  52888 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0076568000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1770781841 . This is a "HEALTHNET TRICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "US DEPT OF LABOR" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1770781841 . This is a "4MOST" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "COMP NET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "CIGNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1072922 . This is a "BRICKSTREET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "MOUNTAIN STATE BCBS" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: PENDING . This is a "SELECT NET" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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