Provider Demographics
NPI:1104865385
Name:VIETS, SANDY L
Entity Type:Individual
Prefix:MISS
First Name:SANDY
Middle Name:L
Last Name:VIETS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6063 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HANOVERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44423-8648
Mailing Address - Country:US
Mailing Address - Phone:330-222-2111
Mailing Address - Fax:
Practice Address - Street 1:6063 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:HANOVERTON
Practice Address - State:OH
Practice Address - Zip Code:44423-8648
Practice Address - Country:US
Practice Address - Phone:330-222-2111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2539257Medicaid