Provider Demographics
NPI:1265511810
Name:VITOSH, LECIA A (PA-C, APRN)
Entity Type:Individual
Prefix:MS
First Name:LECIA
Middle Name:A
Last Name:VITOSH
Suffix:
Gender:F
Credentials:PA-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2248
Mailing Address - Country:US
Mailing Address - Phone:402-643-4800
Mailing Address - Fax:402-646-4635
Practice Address - Street 1:250 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2248
Practice Address - Country:US
Practice Address - Phone:402-643-4800
Practice Address - Fax:402-646-4635
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE552363A00000X
NE110454363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE6250OtherMIDLANDS CHOICE
NE37351OtherBCBS OF NEBRASKA
NE6250OtherMIDLANDS CHOICE
NE273308Medicare PIN