Provider Demographics
NPI:1770995565
Name:VIVIAN D CHANCE ARNP LLC
Entity type:Organization
Organization Name:VIVIAN D CHANCE ARNP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:712-563-4206
Mailing Address - Street 1:222 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:IA
Mailing Address - Zip Code:50025-1103
Mailing Address - Country:US
Mailing Address - Phone:712-563-4206
Mailing Address - Fax:
Practice Address - Street 1:222 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:IA
Practice Address - Zip Code:50025-1103
Practice Address - Country:US
Practice Address - Phone:712-563-4206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA078156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty