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Individual

ANN MALLOY VANCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
200 2ND AVE N, TWIN FALLS, ID 83301-6158
(800) 769-0045
Mailing address
PO BOX 24547, SEATTLE, WA 98124-0547

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1504
ID
363A00000X
Physician Assistant
54086
CA

Other

Enumeration date
12/11/2016
Last updated
12/14/2021
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