Most Relevant Information
Provider Data
| NPI Number: | 1003390980 |
| Provider Name: | PHYLLIS VANCE APRN |
| Entity Type: | Individual |
| Taxonomy Code: | 363LP0808X |
| Specialty: | Nurse Practitioner |
| License Number: | 3012687 |
Most Important Dates
| Enumeration Date: | 09/18/2018 |
| Last Updated: | 02/22/2022 |
Provider Practice Location
10748 VIRGINIA PLZ, SUITE 107
LAVISTA
NE
681283265
Practice Location Phone/Fax
| Phone: | 4029334411 |
| Fax: | 8885075931 |
Provider Mailing Location
10748 VIRGINIA PLZ, SUITE 107
LAVISTA
NE
681283265
Provider Mailing Phone/Fax
| Phone: | 4029334411 |
| Fax: | 8885075931 |