Provider Demographics
NPI:1235517756
Name:VITENAS, SARAH MORALES (CPNP)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MORALES
Last Name:VITENAS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9775 HIGHWAY 190
Mailing Address - Street 2:SUITE F
Mailing Address - City:WALKER
Mailing Address - State:LA
Mailing Address - Zip Code:70785
Mailing Address - Country:US
Mailing Address - Phone:225-243-7716
Mailing Address - Fax:225-243-7754
Practice Address - Street 1:9775 FLORIDA BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:WALKER
Practice Address - State:LA
Practice Address - Zip Code:70785-7801
Practice Address - Country:US
Practice Address - Phone:225-243-7716
Practice Address - Fax:225-243-7754
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LARN134320163WP0200X
LAAP08222363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2395122Medicaid