Provider Demographics
NPI:1447315122
Name:NANCE, DESHONE T (LPN)
Entity type:Individual
Prefix:MRS
First Name:DESHONE
Middle Name:T
Last Name:NANCE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 ROEBUCK RD NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-2562
Mailing Address - Country:US
Mailing Address - Phone:334-339-0053
Mailing Address - Fax:
Practice Address - Street 1:1509 WILDWOOD AVE
Practice Address - Street 2:APT C4
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31906-2096
Practice Address - Country:US
Practice Address - Phone:706-576-6657
Practice Address - Fax:706-544-2144
Is Sole Proprietor?:No
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2-047007164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse