MEDICARE: DARRELL E VANCE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician

General Provider Information

NPI Number	:	1669565628
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL E VANCE

Provider Business Mailing Address
First Line	:	507 WALL ST
Second Line	:
City	:	WINDSOR
State	:	CA
Zip	:	95492-9522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	599 TOMALES RD
Second Line	:	RALPH R. NIX CLINIC
City	:	PETALUMA
State	:	CA
Zip	:	94952-5002
Country	:	US
Telephone Number	:	707-765-7200
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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Directions to “ DARRELL E VANCE ” Practice Location

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