Provider Demographics
NPI:1356430417
Name:LANCE, NANCY (RPA-C)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:LANCE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10988 BENNETT-STATE ROAD
Mailing Address - Street 2:
Mailing Address - City:FROESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062
Mailing Address - Country:US
Mailing Address - Phone:716-363-6050
Mailing Address - Fax:833-471-6206
Practice Address - Street 1:10988 BENNETT-STATE ROAD
Practice Address - Street 2:
Practice Address - City:FROESTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14062
Practice Address - Country:US
Practice Address - Phone:716-363-6050
Practice Address - Fax:833-471-6206
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001523-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00347544Medicaid
NY00347544Medicaid
NYDD1088Medicare ID - Type Unspecified