| Doctor Name: | MRS. ELIZABETH E PROVANCE |
| NPI Number: | 1114051166 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 46027 |
| Business Practice Address: | 426 8th St Glen Dale, WV - 260381451 |
| Business Phone Number: | 3048435041 |
| Business Fax Number: | |
| Mailing Address: | 704 Provance Ln, DALLAS |
| State: | WV |
| Postal Code: | 260363034 |
| Phone Number: | 3045474065 |
| Fax Number: | |
| NPI Enumeration Date: | 03/14/2007 |
| NPI Last Update Date: | 01/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 46027 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |