Provider Demographics
NPI:1942242458
Name:VANCE, REBECCA M (APRN)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:VANCE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Mailing Address - Street 1:1492 W ANTELOPE DR
Mailing Address - Street 2:#206
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1139
Mailing Address - Country:US
Mailing Address - Phone:801-776-0567
Mailing Address - Fax:801-776-0595
Practice Address - Street 1:1492 W ANTELOPE DR
Practice Address - Street 2:#206
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1139
Practice Address - Country:US
Practice Address - Phone:801-776-0567
Practice Address - Fax:801-776-0595
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT276416-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTD3698Medicare UPIN
UTU000093716Medicare PIN