Individual
CARLY JEAN VANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
400 W SEVENTH ST, FREDERICK, MD 21701-4506
(410) 507-3452
Mailing address
400 W SEVENTH ST, FREDERICK, MD 21701-4506
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
C08941
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2022
Last updated
08/01/2023
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