Provider Demographics
NPI:1851959688
Name:LYTLE, VANETTA
Entity Type:Individual
Prefix:
First Name:VANETTA
Middle Name:
Last Name:LYTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OLD KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:BELLMAWR
Mailing Address - State:NJ
Mailing Address - Zip Code:08031-2909
Mailing Address - Country:US
Mailing Address - Phone:929-392-5984
Mailing Address - Fax:
Practice Address - Street 1:25 OLD KINGS HWY
Practice Address - Street 2:
Practice Address - City:BELLMAWR
Practice Address - State:NJ
Practice Address - Zip Code:08031-2909
Practice Address - Country:US
Practice Address - Phone:929-392-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist