Provider Demographics
NPI:1558074831
Name:VITALPATROL LLC
Entity Type:Organization
Organization Name:VITALPATROL LLC
Other - Org Name:QUADRA HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PALAKANIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:385-707-7175
Mailing Address - Street 1:2820 ARAGON TERRACE WAY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1686
Mailing Address - Country:US
Mailing Address - Phone:385-707-7175
Mailing Address - Fax:
Practice Address - Street 1:2820 ARAGON TERRACE WAY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1686
Practice Address - Country:US
Practice Address - Phone:385-707-7175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty