Provider Demographics
NPI:1629788393
Name:VANCE, AMANDA S M (LPN)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:S M
Last Name:VANCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7815 IVANDALE DR
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-4821
Mailing Address - Country:US
Mailing Address - Phone:216-855-5069
Mailing Address - Fax:
Practice Address - Street 1:8787 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44129-6809
Practice Address - Country:US
Practice Address - Phone:216-739-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPN.158736.MEDS-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse