Provider Demographics
NPI:1780313866
Name:VI SANO
Entity type:Organization
Organization Name:VI SANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:AGACNP-BC
Authorized Official - Phone:330-692-1641
Mailing Address - Street 1:7556 STATE ROUTE 45 STE B
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-9807
Mailing Address - Country:US
Mailing Address - Phone:330-870-4127
Mailing Address - Fax:330-870-4139
Practice Address - Street 1:7556 STATE ROUTE 45 STE B
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-9807
Practice Address - Country:US
Practice Address - Phone:330-870-4127
Practice Address - Fax:330-870-4139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-06
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0381705Medicaid
OH0115037Medicaid