Provider Demographics
NPI:1285687699
Name:VIETS, CHRISTA MICHELE
Entity Type:Individual
Prefix:
First Name:CHRISTA
Middle Name:MICHELE
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 1:9738 WAYNE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9740
Mailing Address - Country:US
Mailing Address - Phone:330-424-3479
Mailing Address - Fax:
Practice Address - Street 1:9738 WAYNE BRIDGE RD
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9740
Practice Address - Country:US
Practice Address - Phone:330-424-3479
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2107053374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2107053Medicaid