Individual
LORRAINE C ANTONIOLI VANCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNFA
Contact information
Practice address
1850 N CENTRAL AVE, SUITE 1600, PHOENIX, AZ 85004-4527
(602) 262-8900
(602) 445-4079
Mailing address
PO BOX 34864, PHOENIX, AZ 85067-4864
(602) 744-4760
(602) 445-4079
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
RN063282
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187387
—
AZ
01
—
AZ0162540
BCBS OF AZ
AZ
Enumeration date
02/21/2006
Last updated
02/10/2010
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