Provider Demographics
NPI:1275392813
Name:VITALE, TARA (STNA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:VITALE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:WHITELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:STNA
Mailing Address - Street 1:243 SLEEPY HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713-1160
Mailing Address - Country:US
Mailing Address - Phone:740-359-5638
Mailing Address - Fax:
Practice Address - Street 1:243 SLEEPY HOLLOW DR
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713-1160
Practice Address - Country:US
Practice Address - Phone:740-359-5638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide