MEDICARE: COLLIN LANDRY VANN I

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063218071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLIN LANDRY VANN I

Provider Business Mailing Address
First Line	:	2414 SAINT CHARLES AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2719
Country	:	US
Telephone Number	:	229-560-3445
Fax Number	:

Provider Business Practice Location Address
First Line	:	2414 SAINT CHARLES AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-2719
Country	:	US
Telephone Number	:	229-560-3445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2025
Last Update Date	:	02/20/2025

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Directions to “ COLLIN LANDRY VANN I ” Practice Location

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