Provider Demographics
NPI:1295184802
Name:VITALE, KIRSTEN B (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:B
Last Name:VITALE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55906-4265
Mailing Address - Country:US
Mailing Address - Phone:507-226-5747
Mailing Address - Fax:
Practice Address - Street 1:1216 2ND ST SW
Practice Address - Street 2:ALFRED 3-416
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-1906
Practice Address - Country:US
Practice Address - Phone:507-293-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-06
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1199855163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse