Provider Demographics
NPI:1326516873
Name:FLUENCE, LANCE (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:FLUENCE
Suffix:
Gender:M
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 XERXES CT N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55444-1876
Mailing Address - Country:US
Mailing Address - Phone:952-465-9967
Mailing Address - Fax:763-210-6873
Practice Address - Street 1:7912 XERXES CT N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55444-1876
Practice Address - Country:US
Practice Address - Phone:952-465-9967
Practice Address - Fax:763-210-6873
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN384592251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health