Provider Demographics
NPI:1881852861
Name:VANHORN, MINDY JO
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:JO
Last Name:VANHORN
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 1:310 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTONVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44490-9633
Mailing Address - Country:US
Mailing Address - Phone:330-853-2892
Mailing Address - Fax:
Practice Address - Street 1:310 HIGH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTONVILLE
Practice Address - State:OH
Practice Address - Zip Code:44490-9633
Practice Address - Country:US
Practice Address - Phone:330-853-2892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2775797374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2775797Medicaid