Provider Demographics
NPI:1275118606
Name:VANCE, PATRICIA GALE
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:GALE
Last Name:VANCE
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 1:6549 MCCLELLAN HWY
Mailing Address - Street 2:
Mailing Address - City:WEST HAMLIN
Mailing Address - State:WV
Mailing Address - Zip Code:25571-8058
Mailing Address - Country:US
Mailing Address - Phone:304-654-5987
Mailing Address - Fax:
Practice Address - Street 1:6549 MCCLELLAN HWY
Practice Address - Street 2:
Practice Address - City:WEST HAMLIN
Practice Address - State:WV
Practice Address - Zip Code:25571-8058
Practice Address - Country:US
Practice Address - Phone:304-654-5987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant