Basic Information
| Provider Information | |||||||||
| NPI: | 1144515610 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NANCE | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | ALLEN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 S 3RD ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182337880 | ||||||||
| FaxNumber: | 6182224792 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 S 3RD ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182337880 | ||||||||
| FaxNumber: | 6182224792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2011 | ||||||||
| LastUpdateDate: | 03/13/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 125.059709 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 8570024-1204 | UT | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.