Provider Demographics
NPI:1164742870
Name:VITALITY HEALTH AND WELLNESS PLLC
Entity Type:Organization
Organization Name:VITALITY HEALTH AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:I
Authorized Official - Last Name:SPEECE
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN, ANP
Authorized Official - Phone:252-364-2802
Mailing Address - Street 1:1429 E FIRETOWER RD
Mailing Address - Street 2:STE 104
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5731
Mailing Address - Country:US
Mailing Address - Phone:252-364-2802
Mailing Address - Fax:
Practice Address - Street 1:1429 E FIRE TOWER RD
Practice Address - Street 2:STE 104
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5730
Practice Address - Country:US
Practice Address - Phone:252-364-2802
Practice Address - Fax:252-207-0709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004454363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty