Provider Demographics
NPI:1780865436
Name:VANNESS, SARAH ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:VANNESS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4256 DOWNING HILL ROAD
Mailing Address - Street 2:
Mailing Address - City:MALTA
Mailing Address - State:OH
Mailing Address - Zip Code:43758
Mailing Address - Country:US
Mailing Address - Phone:740-962-6727
Mailing Address - Fax:740-962-6727
Practice Address - Street 1:4256 DOWNING HILL ROAD
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:OH
Practice Address - Zip Code:43758
Practice Address - Country:US
Practice Address - Phone:740-962-6727
Practice Address - Fax:740-962-6727
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 090938164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2685509Medicaid