Provider Demographics
NPI:1770781841
Name:VANCE, VIOLET R (ARNP)
Entity type:Individual
Prefix:MRS
First Name:VIOLET
Middle Name:R
Last Name:VANCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 70 BOX 200
Mailing Address - Street 2:
Mailing Address - City:LENORE
Mailing Address - State:WV
Mailing Address - Zip Code:25676-9702
Mailing Address - Country:US
Mailing Address - Phone:304-475-3834
Mailing Address - Fax:
Practice Address - Street 1:306 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4095
Practice Address - Country:US
Practice Address - Phone:606-237-4943
Practice Address - Fax:606-237-1797
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV52888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0076568000Medicaid
WV1770781841OtherHEALTHNET TRICARE
WVPENDINGOtherUS DEPT OF LABOR
WV1770781841Other4MOST
WVPENDINGOtherCOMP NET
WVPENDINGOtherCIGNA
WV1072922OtherBRICKSTREET
WVPENDINGOtherMOUNTAIN STATE BCBS
WVPENDINGOtherSELECT NET
WVPENDINGOtherCOMP NET