Provider Demographics
NPI:1467227082
Name:VITA, JODI ELAINE
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:ELAINE
Last Name:VITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1337 IVES RD
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-4622
Mailing Address - Country:US
Mailing Address - Phone:401-829-3053
Mailing Address - Fax:
Practice Address - Street 1:1337 IVES RD
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-4622
Practice Address - Country:US
Practice Address - Phone:401-829-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-24
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTRN204019163W00000X
RIRN56723163W00000X
MARN2311972163W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163W00000XNursing Service ProvidersRegistered Nurse