Provider Demographics
NPI:1720715550
Name:SPANN, VANYCE DARIELL
Entity Type:Individual
Prefix:
First Name:VANYCE
Middle Name:DARIELL
Last Name:SPANN
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:FLUSHING MERCY, 2521 N ELMS RD. FLUSHING, MI 48433
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:MI
Mailing Address - Zip Code:48433
Mailing Address - Country:US
Mailing Address - Phone:866-498-3909
Mailing Address - Fax:
Practice Address - Street 1:111174 HIGHLAND RD
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:MI
Practice Address - Zip Code:48353
Practice Address - Country:US
Practice Address - Phone:810-991-1114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician