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General NPI Number Information
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NPI Number | 1407885148
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Entity Type | Individual
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Provider Name | MARY E. VANCE FNP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 06/27/2020
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Provider Practice Location Address
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Address Line | 9900 BREN ROAD EAST MAIL ROUTE NM
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City | 008-B213
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State | MN
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Zip | 55343
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Country | US
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Telephone | 423-388-1730
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Fax |
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Provider Business Mailing Address
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Address Line | 8735 KINGSPORT HWY
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City | CHUCKEY
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State | TN
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Zip | 37641-6908
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Country | US
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Telephone | 423-329-4610
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN007047
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License Number State | TN
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