Provider Demographics
NPI:1013223452
Name:M.YANSANEH IP
Entity Type:Organization
Organization Name:M.YANSANEH IP
Other - Org Name:M.YANSANEH IP
Other - Org Type:Other Name
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:MAYENI
Authorized Official - Middle Name:
Authorized Official - Last Name:YANSANEH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:513-544-1116
Mailing Address - Street 1:3537 HEATH TRCE
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7706
Mailing Address - Country:US
Mailing Address - Phone:513-544-1116
Mailing Address - Fax:
Practice Address - Street 1:3537 HEATH TRCE
Practice Address - Street 2:CANAL WINCHESTER
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-7706
Practice Address - Country:US
Practice Address - Phone:513-544-1116
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1324813140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric