Provider Demographics
NPI:1114221470
Name:LANCE, ESPRI KEATON
Entity Type:Individual
Prefix:
First Name:ESPRI
Middle Name:KEATON
Last Name:LANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 S BENT ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-2714
Mailing Address - Country:US
Mailing Address - Phone:307-754-5101
Mailing Address - Fax:307-754-4600
Practice Address - Street 1:146 S BENT ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2714
Practice Address - Country:US
Practice Address - Phone:307-754-5101
Practice Address - Fax:307-754-4600
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator