Provider Demographics
NPI:1912604513
Name:VANCE, JEANNIE I
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:I
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 1:4930 TOWNSHIP ROAD 383
Mailing Address - Street 2:
Mailing Address - City:GLENFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43739-9706
Mailing Address - Country:US
Mailing Address - Phone:740-605-7032
Mailing Address - Fax:
Practice Address - Street 1:562 VESPER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-7611
Practice Address - Country:US
Practice Address - Phone:740-364-1604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide