Healthcare Provider Details

I. General information

NPI: 1225612831
Provider Name (Legal Business Name): HANNAH H VANCE MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1805 NW PLATTE RD STE 120
RIVERSIDE MO
64150-7500
US

IV. Provider business mailing address

6601 VAUGHT RANCH RD STE 200
AUSTIN TX
78730-2309
US

V. Phone/Fax

Practice location:
  • Phone: 816-205-8120
  • Fax:
Mailing address:
  • Phone: 512-628-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF03210035
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: