Provider Demographics
NPI:1821232208
Name:VUTLA, VIJAYA RAMI (LPN)
Entity Type:Individual
Prefix:MS
First Name:VIJAYA
Middle Name:RAMI
Last Name:VUTLA
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 1:1050 W GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2215
Mailing Address - Country:US
Mailing Address - Phone:315-424-3744
Mailing Address - Fax:315-424-3745
Practice Address - Street 1:1050 W GENESEE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-2215
Practice Address - Country:US
Practice Address - Phone:315-424-3744
Practice Address - Fax:315-424-3745
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-29
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2404731164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse