Doctor Name: | RYAN CARPENTER VANN |
NPI Number: | 1013106038 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA-C |
License Number: | 0010-01085 |
Business Practice Address: | 147 Peachtree Lane Advance, NC - 270066907 |
Business Phone Number: | 3367162255 |
Business Fax Number: | 3369402561 |
Mailing Address: | Po Box 344, WINSTON SALEM |
State: | NC |
Postal Code: | 271020344 |
Phone Number: | 3367162255 |
Fax Number: | 3369402561 |
NPI Enumeration Date: | 10/16/2007 |
NPI Last Update Date: | 04/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 0010-01085 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |