Provider Demographics
NPI:1003635343
Name:LOCH, VANDARA
Entity type:Individual
Prefix:
First Name:VANDARA
Middle Name:
Last Name:LOCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7732 FARM HILL DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9105
Mailing Address - Country:US
Mailing Address - Phone:614-209-4455
Mailing Address - Fax:
Practice Address - Street 1:7732 FARM HILL DR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9105
Practice Address - Country:US
Practice Address - Phone:614-209-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker