Provider Demographics
NPI:1346364213
Name:SHUMAKER, VIVIAN LORAINE
Entity Type:Individual
Prefix:MRS
First Name:VIVIAN
Middle Name:LORAINE
Last Name:SHUMAKER
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 1:9685 COUNTY ROAD 38
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-9301
Mailing Address - Country:US
Mailing Address - Phone:419-468-7350
Mailing Address - Fax:
Practice Address - Street 1:9685 COUNTY ROAD 38
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-9301
Practice Address - Country:US
Practice Address - Phone:419-468-7350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
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
OH2371106Medicaid