Provider Demographics
NPI:1386489060
Name:VANCE, ASHA ELAINE
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:ELAINE
Last Name:VANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 LINDEN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3018
Mailing Address - Country:US
Mailing Address - Phone:937-815-7488
Mailing Address - Fax:
Practice Address - Street 1:637 S. CENTER ST.
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45506
Practice Address - Country:US
Practice Address - Phone:937-815-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator