Provider Demographics
NPI:1497197453
Name:VITALE, VALERIE REBECCA (NP)
Entity Type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:REBECCA
Last Name:VITALE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:REBECCA
Other - Last Name:BOOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13230 MAPLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6105
Mailing Address - Country:US
Mailing Address - Phone:703-850-1072
Mailing Address - Fax:
Practice Address - Street 1:2730 PROSPERITY AVE STE D
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4330
Practice Address - Country:US
Practice Address - Phone:703-226-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001212690163W00000X
VA0024171021363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics