Provider Demographics
NPI:1508991266
Name:WITALIS, SALLY ANN (RN)
Entity Type:Individual
Prefix:
First Name:SALLY ANN
Middle Name:
Last Name:WITALIS
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 1:13260 COLONIAL WOODSDR
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004
Mailing Address - Country:US
Mailing Address - Phone:716-937-7930
Mailing Address - Fax:
Practice Address - Street 1:1200 E AND WEST RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-3604
Practice Address - Country:US
Practice Address - Phone:585-343-4474
Practice Address - Fax:585-343-6768
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3556461163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse