Provider Demographics
NPI:1992199939
Name:VANCE, MORI
Entity Type:Individual
Prefix:MRS
First Name:MORI
Middle Name:
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 1:135 E HAWES AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-3021
Mailing Address - Country:US
Mailing Address - Phone:559-355-0935
Mailing Address - Fax:559-493-5110
Practice Address - Street 1:135 E HAWES
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-3021
Practice Address - Country:US
Practice Address - Phone:559-355-0935
Practice Address - Fax:559-493-5110
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA175545164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse