Provider Demographics
NPI:1740492248
Name:SANCHO, WILLIA J (LPN)
Entity type:Individual
Prefix:MRS
First Name:WILLIA
Middle Name:J
Last Name:SANCHO
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 1:4749 REMMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321
Mailing Address - Country:US
Mailing Address - Phone:330-668-6074
Mailing Address - Fax:216-536-2207
Practice Address - Street 1:4749 REMMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321
Practice Address - Country:US
Practice Address - Phone:330-668-6074
Practice Address - Fax:216-536-2207
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH102154164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2197206Medicaid