Provider Demographics
NPI:1558157958
Name:VANCE, MALIA
Entity type:Individual
Prefix:
First Name:MALIA
Middle Name:
Last Name:VANCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-3048
Mailing Address - Country:US
Mailing Address - Phone:402-614-0413
Mailing Address - Fax:402-315-3784
Practice Address - Street 1:2717 S 88TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3048
Practice Address - Country:US
Practice Address - Phone:402-614-0413
Practice Address - Fax:402-315-3784
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider