Provider Demographics
NPI:1912373101
Name:VANCE, JESSIE (RRT)
Entity Type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:VANCE
Suffix:
Gender:M
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RAVINE RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3220
Mailing Address - Country:US
Mailing Address - Phone:828-708-0612
Mailing Address - Fax:
Practice Address - Street 1:2 RAVINE RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3220
Practice Address - Country:US
Practice Address - Phone:828-708-0612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4660-282279E0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279E0002XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredEmergency Care