Basic Information
Provider Information
NPI: 1730624073
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NANCE
FirstName: ANNE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN, NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 650859
Address2: DEPT 710
City: DALLAS
State: TX
PostalCode: 752655302
CountryCode: US
TelephoneNumber: 4097476240
FaxNumber:  
Practice Location
Address1: 301 UNIVERSITY BLVD
Address2:  
City: GALVESTON
State: TX
PostalCode: 775555302
CountryCode: US
TelephoneNumber: 4097470338
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/22/2016
LastUpdateDate: 08/02/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/02/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000XAP131116TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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