Provider Demographics
NPI:1861150146
Name:VINSON-MUNCY, LISA LATONIA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LATONIA
Last Name:VINSON-MUNCY
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 1:98 WINCO LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSON
Mailing Address - State:WV
Mailing Address - Zip Code:25661-9606
Mailing Address - Country:US
Mailing Address - Phone:304-601-2929
Mailing Address - Fax:
Practice Address - Street 1:98 WINCO LN
Practice Address - Street 2:
Practice Address - City:WILLIAMSON
Practice Address - State:WV
Practice Address - Zip Code:25661-9606
Practice Address - Country:US
Practice Address - Phone:304-601-2929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant