Basic Information
| Provider Information | |||||||||
| NPI: | 1225562598 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANCE | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | CRNA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | COPHER | ||||||||
| OtherFirstName: | JAMIE | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 13515 BARRETT PARKWAY DR | ||||||||
| Address2: | STE 170 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630215870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147752811 | ||||||||
| FaxNumber: | 3147752821 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 S WOODS MILL RD | ||||||||
| Address2: | STE 140 | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144851101 | ||||||||
| FaxNumber: | 3144851104 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2017 | ||||||||
| LastUpdateDate: | 04/13/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 2017011124 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.