Provider Demographics
NPI:1689264079
Name:BELLA VITA HEALTH AND WELLNESS
Entity Type:Organization
Organization Name:BELLA VITA HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:GERISE
Authorized Official - Last Name:VIGNAROLI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-BC
Authorized Official - Phone:307-258-3222
Mailing Address - Street 1:7220 W RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-9296
Mailing Address - Country:US
Mailing Address - Phone:307-258-3222
Mailing Address - Fax:
Practice Address - Street 1:7220 W RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-9296
Practice Address - Country:US
Practice Address - Phone:307-258-3222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care