Healthcare Provider Details

I. General information

NPI: 1689206807
Provider Name (Legal Business Name): VENAFLUX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 SOUTHMOOR LN
FORT MILL SC
29707-9117
US

IV. Provider business mailing address

91 LANE HOLLER
BELMONT NC
28012-3656
US

V. Phone/Fax

Practice location:
  • Phone: 801-810-8346
  • Fax:
Mailing address:
  • Phone: 828-243-3217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDSEY LANCE
Title or Position: MEDICAL DIRECTOR
Credential: ACNP-BC
Phone: 828-243-3217