Provider Demographics
NPI:1427635135
Name:VIANO, LACEY ANN
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:ANN
Last Name:VIANO
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 1:205 N 2ND AVE APT 7
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-1134
Mailing Address - Country:US
Mailing Address - Phone:815-342-0895
Mailing Address - Fax:
Practice Address - Street 1:205 N 2ND AVE APT 7
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-1134
Practice Address - Country:US
Practice Address - Phone:815-342-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered