Provider Demographics
NPI:1437814027
Name:LANCE, BRIANNA HODGES (NP)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:HODGES
Last Name:LANCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-4650
Mailing Address - Fax:336-716-4318
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-2311
Practice Address - Country:US
Practice Address - Phone:336-716-4650
Practice Address - Fax:336-716-4318
Is Sole Proprietor?:No
Enumeration Date:2021-11-08
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLANC-H1SW8207RN0300X
NC5015457363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology