Provider Demographics
NPI:1447098124
Name:VANCE, PAMELA SUE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUE
Last Name:VANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MATHIS ADDITION
Mailing Address - Street 2:
Mailing Address - City:MOUNT GAY
Mailing Address - State:WV
Mailing Address - Zip Code:25637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:104 MATHIS ADDITION
Practice Address - Street 2:
Practice Address - City:MOUNT GAY
Practice Address - State:WV
Practice Address - Zip Code:25637
Practice Address - Country:US
Practice Address - Phone:304-733-1094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant