Individual
MRS. JAMIE LOUISE VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1322 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1322
(304) 647-1139
(304) 647-3006
Mailing address
1322 MAPLEWOOD AVE, RONCEVERTE, WV 24970-1322
(304) 647-1139
(304) 647-3006
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2754
WV
207R00000X
Internal Medicine Physician
Primary
2754
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1720349475
—
WV
Enumeration date
05/30/2012
Last updated
03/06/2022
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