Provider Demographics
NPI:1699367359
Name:CARLISLE, VIVIAN YONINA
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:YONINA
Last Name:CARLISLE
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 1:1330 E WHEELING ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3355
Mailing Address - Country:US
Mailing Address - Phone:740-274-3665
Mailing Address - Fax:
Practice Address - Street 1:1330 E WHEELING ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3355
Practice Address - Country:US
Practice Address - Phone:740-274-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide