Provider Demographics
NPI:1659011161
Name:VANCE, JEAN M
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:VANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 EMMAUS
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:VI
Mailing Address - Zip Code:00830-9587
Mailing Address - Country:US
Mailing Address - Phone:340-227-6061
Mailing Address - Fax:
Practice Address - Street 1:9901 EMMAUS
Practice Address - Street 2:
Practice Address - City:ST JOHN
Practice Address - State:VI
Practice Address - Zip Code:00830-9587
Practice Address - Country:US
Practice Address - Phone:340-227-6061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter