Individual
MRS. AMANDA GRACE VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1965 S FREMONT AVE STE 130, SPRINGFIELD, MO 65804-2252
(417) 820-5150
(417) 820-5155
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2001018472
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
427491303
—
MO
Enumeration date
01/30/2007
Last updated
05/30/2013
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