Provider Demographics
NPI:1467712570
Name:VITALCARE MEDICAL PRACTICE
Entity Type:Organization
Organization Name:VITALCARE MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ARNP
Authorized Official - Prefix:
Authorized Official - First Name:VEOMANY
Authorized Official - Middle Name:
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:316-650-7620
Mailing Address - Street 1:1302 S AUBURN HILLS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67235-3422
Mailing Address - Country:US
Mailing Address - Phone:316-650-7620
Mailing Address - Fax:
Practice Address - Street 1:1302 S AUBURN HILLS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67235-3422
Practice Address - Country:US
Practice Address - Phone:316-650-7620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46229363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty