Provider Demographics
NPI:1033700364
Name:VITALITY HEALTH PLLC
Entity Type:Organization
Organization Name:VITALITY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KVEUM
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:701-263-1435
Mailing Address - Street 1:PO BOX 124
Mailing Address - Street 2:
Mailing Address - City:WESTHOPE
Mailing Address - State:ND
Mailing Address - Zip Code:58793-0124
Mailing Address - Country:US
Mailing Address - Phone:701-245-6300
Mailing Address - Fax:855-435-5155
Practice Address - Street 1:310 2ND AVE E
Practice Address - Street 2:
Practice Address - City:WESTHOPE
Practice Address - State:ND
Practice Address - Zip Code:58793-4027
Practice Address - Country:US
Practice Address - Phone:701-245-6300
Practice Address - Fax:855-435-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-29
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1477532Medicaid