Healthcare Provider Details

I. General information

NPI: 1528883832
Provider Name (Legal Business Name): REBEKAH LILLIAN VANCE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 W PINE ST
PINEDALE WY
82941-5317
US

IV. Provider business mailing address

PO BOX 1781
PINEDALE WY
82941-1781
US

V. Phone/Fax

Practice location:
  • Phone: 307-367-7647
  • Fax:
Mailing address:
  • Phone: 307-231-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number55325
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number55325
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number55325
License Number StateWY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number55325
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number55325
License Number StateWY
# 6
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55325
License Number StateWY
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number55325
License Number StateWY
# 8
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number55325
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: