| NPI | 1518944255 |
|---|---|
| Former Name | DEANNA RAE VANCE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: WV 01208) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 01208) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2016-09-01 |