Provider Demographics
NPI:1629665633
Name:LANCE, JAMES LEE III
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:LEE
Last Name:LANCE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:SHINNSTON
Mailing Address - State:WV
Mailing Address - Zip Code:26431-1421
Mailing Address - Country:US
Mailing Address - Phone:304-629-4232
Mailing Address - Fax:
Practice Address - Street 1:521 EAST AVE
Practice Address - Street 2:
Practice Address - City:SHINNSTON
Practice Address - State:WV
Practice Address - Zip Code:26431-1421
Practice Address - Country:US
Practice Address - Phone:304-629-4232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant