Healthcare Provider Details

I. General information

NPI: 1073679304
Provider Name (Legal Business Name): NANCY JEANNE VANZILE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 FOREST AVE
MAYSVILLE KY
41056-1411
US

IV. Provider business mailing address

611 FOREST AVE
MAYSVILLE KY
41056-1411
US

V. Phone/Fax

Practice location:
  • Phone: 606-564-4016
  • Fax: 606-564-4016
Mailing address:
  • Phone: 606-564-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLP0319
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2007-15
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: