Healthcare Provider Details

I. General information

NPI: 1699367359
Provider Name (Legal Business Name): VIVIAN YONINA CARLISLE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 E WHEELING ST
LANCASTER OH
43130-3355
US

IV. Provider business mailing address

1330 E WHEELING ST
LANCASTER OH
43130-3355
US

V. Phone/Fax

Practice location:
  • Phone: 740-274-3665
  • Fax:
Mailing address:
  • Phone: 740-274-3665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: