Provider Demographics
NPI:1396839353
Name:VANCE, AMANDA NICOLE (INDEPENDENT PCA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:NICOLE
Last Name:VANCE
Suffix:
Gender:F
Credentials:INDEPENDENT PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8670 WRIGHT RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-9705
Mailing Address - Country:US
Mailing Address - Phone:937-763-8405
Mailing Address - Fax:
Practice Address - Street 1:8670 WRIGHT RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-9705
Practice Address - Country:US
Practice Address - Phone:937-763-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor