Provider Demographics
NPI:1023643194
Name:VANCE, DALE (FNP)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N HOUSTON RD
Mailing Address - Street 2:STE 140E
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093
Mailing Address - Country:US
Mailing Address - Phone:478-975-6880
Mailing Address - Fax:478-975-6869
Practice Address - Street 1:223 N HOUSTON RD
Practice Address - Street 2:STE 140E
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093
Practice Address - Country:US
Practice Address - Phone:478-975-6880
Practice Address - Fax:478-975-6869
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN269964363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily