=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710743976
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | IVAN LUIS CASIANO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 05/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 ELIZABETH PL
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45417-3445
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-813-1737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8364 MARTZ PAULIN RD
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45005-4020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-465-9371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | LPN.182996.MED-IV
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN.544818
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------