Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD181361 | OR |
N | 207Q00000X | Family Doctor | MD60734244 | WA |
N | 207Q00000X | Family Doctor | MED-PHYS-LIC-53568 | MT |
N | 207VX0000X | Obstetrician | MD181361 | OR |
NPI | 1164834347 |
---|---|
Provider Name | Dr. Chardonnay Vance |
First Address | White Salmon, WA 98672-0886 |
Second Address | White Salmon, WA 98672-8974 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2014 |
Last Update Date | 08/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2080300 | (05) | WA |