Provider Demographics
NPI:1528402401
Name:VANCE, CHERIE L (FNP/BC)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:L
Last Name:VANCE
Suffix:
Gender:F
Credentials:FNP/BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 240
Mailing Address - Street 2:
Mailing Address - City:BRADSHAW
Mailing Address - State:WV
Mailing Address - Zip Code:24817-0240
Mailing Address - Country:US
Mailing Address - Phone:304-967-5034
Mailing Address - Fax:304-906-2417
Practice Address - Street 1:240 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BRADSHAW
Practice Address - State:WV
Practice Address - Zip Code:24817
Practice Address - Country:US
Practice Address - Phone:304-967-5034
Practice Address - Fax:304-906-2417
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV81993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily