Individual
CAROL KLETT VANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1619 CURLEW DR STE 6, AMMON, ID 83406-4719
(208) 523-4688
(208) 523-4990
Mailing address
1619 CURLEW DR STE 6, AMMON, ID 83406-4719
(208) 523-4688
(208) 523-4990
Taxonomy
Speciality
Code
Description
License number
State
2080P0008X
Pediatric Neurodevelopmental Disabilities Physician
Primary
M9751
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010158422
REGENCE BLUESHIELD
ID
01
—
B6254
BCBS
ID
Enumeration date
12/26/2006
Last updated
03/05/2008
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