Provider Demographics
NPI:1821314063
Name:VECCIA, RACHEL ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANNE
Last Name:VECCIA
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 1:9078 STORE DR
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:OH
Mailing Address - Zip Code:44288-1433
Mailing Address - Country:US
Mailing Address - Phone:330-307-5308
Mailing Address - Fax:330-326-0107
Practice Address - Street 1:9078 STORE DR
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:OH
Practice Address - Zip Code:44288-1433
Practice Address - Country:US
Practice Address - Phone:330-307-5308
Practice Address - Fax:330-326-0107
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135027164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2460902Medicaid