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NPI Code Detail

MEDICARE: BRADIE LEE VANCE RN

MEDICARE: BRADIE LEE VANCE RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163WE0003XEmergency Registered Nurse116506WV

General Provider Information

NPI Number : 1538093331
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADIE LEE VANCE RN
Provider Business Mailing Address
First Line : 124 WOODLAND RD
Second Line :
City : HINTON
State : WV
Zip : 25951-1169
Country : US
Telephone Number : 304-712-8489
Fax Number :
Provider Business Practice Location Address
First Line : 122 12TH ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2312
Country : US
Telephone Number : 800-487-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2026
Last Update Date : 06/09/2026

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Directions to “ BRADIE LEE VANCE RN” Practice Location

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