Individual
MARIANNE PROVANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
983 HOMESTEAD AVE, ALLIANCE, OH 44601-1131
(330) 265-9241
Mailing address
983 HOMESTEAD AVE, ALLIANCE, OH 44601-1131
(330) 265-9241
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
OH
172A00000X
Driver
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7611029
—
OH
Enumeration date
11/16/2020
Last updated
11/16/2020
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