Provider Demographics
NPI:1053700534
Name:VANCE, LYNNE (LAC)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:VANCE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 EVERGREEN DR
Mailing Address - Street 2:SUITE 22
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1032
Mailing Address - Country:US
Mailing Address - Phone:610-358-8822
Mailing Address - Fax:
Practice Address - Street 1:500 EVERGREEN DR
Practice Address - Street 2:SUITE 22
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1032
Practice Address - Country:US
Practice Address - Phone:610-358-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN665301163W00000X
PAAK001121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse