Provider Demographics
NPI:1639379167
Name:LANCE, RENEE MEREE (PA-C)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:MEREE
Last Name:LANCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 BOBCAT WAY
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5169
Mailing Address - Country:US
Mailing Address - Phone:406-452-4433
Mailing Address - Fax:406-452-3399
Practice Address - Street 1:2510 BOBCAT WAY
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5169
Practice Address - Country:US
Practice Address - Phone:406-452-4433
Practice Address - Fax:406-452-3399
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20362363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant