Provider Demographics
NPI:1528007705
Name:VANCE, NICHOLAS C (PA-C)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:C
Last Name:VANCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:484 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508
Practice Address - Country:US
Practice Address - Phone:304-310-2515
Practice Address - Fax:304-310-2511
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVQ48962363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00290270OtherRAILROAD MEDICARE
WVP00290270OtherRRGA
WV001754940OtherMOUNTAIN STATE BLUE SHIEL
WV001754940OtherBCBS
WVPA25361Medicare PIN