Individual
LISA A. PROVANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
0024165328
VA
363LF0000X
Family Nurse Practitioner
Primary
115829
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001104234
RN LICENSE NUMBER
VA
01
—
0024165328
NURSE PRACTITIONER NUMBER
VA
05
—
010114641
—
VA
01
—
014944V57
MEDICARE FOR VHPG
VA
01
—
115829
APRN
WV
Enumeration date
11/08/2005
Last updated
06/08/2024
Update your record
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