Provider Demographics
NPI:1811214620
Name:VLAZZIO, XYDITA C (LPN)
Entity Type:Individual
Prefix:MS
First Name:XYDITA
Middle Name:C
Last Name:VLAZZIO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 NOSTRAND AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-4019
Mailing Address - Country:US
Mailing Address - Phone:646-671-0819
Mailing Address - Fax:
Practice Address - Street 1:1407 N MARTIN LUTHER KING DR
Practice Address - Street 2:108
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-3976
Practice Address - Country:US
Practice Address - Phone:414-943-0248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY326550164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse