Provider Demographics
NPI:1205554193
Name:VITAL WAYS WELLNESS
Entity type:Organization
Organization Name:VITAL WAYS WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINTER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:262-448-3289
Mailing Address - Street 1:N92W17420 APPLETON AVE
Mailing Address - Street 2:SUITE 103#402
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-448-3289
Mailing Address - Fax:262-404-8256
Practice Address - Street 1:834 PIERCE PL
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-9282
Practice Address - Country:US
Practice Address - Phone:262-448-3289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-17
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1841531571OtherPROVIDER-NICOLE
WI1326777095OtherPROVIDER