Provider Demographics
NPI:1578113635
Name:SANCHEZ CARRASCO, WALIAN AYESHAH
Entity Type:Individual
Prefix:MRS
First Name:WALIAN
Middle Name:AYESHAH
Last Name:SANCHEZ CARRASCO
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 1:618 W 1425 N APT B
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1988
Mailing Address - Country:US
Mailing Address - Phone:787-640-2595
Mailing Address - Fax:
Practice Address - Street 1:618 W 1425 N APT B
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1988
Practice Address - Country:US
Practice Address - Phone:787-640-2595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR82981163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse