Provider Demographics
NPI:1114299914
Name:VITALE, MICHELLE SUSAN (APN)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:SUSAN
Last Name:VITALE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07502-1849
Mailing Address - Country:US
Mailing Address - Phone:973-942-3618
Mailing Address - Fax:973-942-7224
Practice Address - Street 1:154 UNION AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07502-1849
Practice Address - Country:US
Practice Address - Phone:973-942-3618
Practice Address - Fax:973-942-7224
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00365700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily