Provider Demographics
NPI:1710285994
Name:VITEZ, CATHY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:LYNN
Last Name:VITEZ
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 1:1057 PYSELL RD
Mailing Address - Street 2:
Mailing Address - City:MC HENRY
Mailing Address - State:MD
Mailing Address - Zip Code:21541-1237
Mailing Address - Country:US
Mailing Address - Phone:301-387-6501
Mailing Address - Fax:
Practice Address - Street 1:1057 PYSELL RD
Practice Address - Street 2:
Practice Address - City:MC HENRY
Practice Address - State:MD
Practice Address - Zip Code:21541-1237
Practice Address - Country:US
Practice Address - Phone:443-478-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR092170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse