Individual
MARY E. VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9900 BREN ROAD EAST, MAIL ROUTE NM, 008-B213, MN 55343
(423) 388-1730
Mailing address
8735 KINGSPORT HWY, CHUCKEY, TN 37641-6908
(423) 329-4610
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
APN007047
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100025524
PHP
TN
05
—
3343736
—
TN
01
—
4117453
BLUECROSSBLUESHIELD
TN
01
—
TN01N4
JOHN DEERE
TN
Enumeration date
07/03/2006
Last updated
06/27/2020
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