Provider Demographics
NPI:1609953868
Name:VANCE, ADRIENNE ELIZABETH (PT, ATC)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:ELIZABETH
Last Name:VANCE
Suffix:
Gender:F
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3741
Mailing Address - Country:US
Mailing Address - Phone:402-486-8501
Mailing Address - Fax:402-486-8581
Practice Address - Street 1:4720 RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-3741
Practice Address - Country:US
Practice Address - Phone:402-486-8501
Practice Address - Fax:402-486-8581
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$Medicaid