Provance, Lisa A.

Provance, Lisa A. is an individual health care provider with primary practice located at Po Box 897 , Morgantown WV 26507-0897. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Provance, Lisa A. can be contacted via phone (304) 285-7100.

Contact Information

Primary practice address
Po Box 897 Morgantown WV 26507-0897
Phone: (304) 285-7100
Fax: (304) 842-2333
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 0024165328 Virginia
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 115829 West Virginia

Profile Details

NPI number 1588645378
LBN Legal business name Provance, Lisa A.
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 8th, 2005
Last updated Jun 8th, 2024 - about 5 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1588645378 NPPES
Virginia Other 0024165328 NURSE PRACTITIONER NUMBER
Virginia Other 115829 NURSE PRACTITIONER NUMBER
Virginia Other 014944V57 NURSE PRACTITIONER NUMBER
Virginia Other 0001104234 NURSE PRACTITIONER NUMBER
Virginia MEDICAID 010114641 NURSE PRACTITIONER NUMBER

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