Provider Demographics
NPI:1063218071
Name:VANN, COLLIN LANDRY I
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:LANDRY
Last Name:VANN
Suffix:I
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2719
Mailing Address - Country:US
Mailing Address - Phone:229-560-3445
Mailing Address - Fax:
Practice Address - Street 1:2414 SAINT CHARLES AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2719
Practice Address - Country:US
Practice Address - Phone:229-560-3445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care