Provider Demographics
NPI:1871851238
Name:PROVAN, NANCY ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY ANN
Middle Name:
Last Name:PROVAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N RICHARDSON AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2125
Mailing Address - Country:US
Mailing Address - Phone:215-855-7747
Mailing Address - Fax:
Practice Address - Street 1:49 N RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2125
Practice Address - Country:US
Practice Address - Phone:215-855-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-009065-22083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine