Provider Demographics
NPI:1487848024
Name:NANCE, CHRISTOPHER LLOYD (CPED)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LLOYD
Last Name:NANCE
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 WICKER ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-4151
Mailing Address - Country:US
Mailing Address - Phone:919-777-0446
Mailing Address - Fax:919-777-0447
Practice Address - Street 1:615 WICKER ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4151
Practice Address - Country:US
Practice Address - Phone:919-777-0446
Practice Address - Fax:919-777-0447
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECPED2407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795309Medicaid
CPED2407OtherAMER BOARD FOR CERTIFICAT