Provider Demographics
NPI:1407689458
Name:KLITUS, THEODORE (RN)
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:KLITUS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19067-4825
Mailing Address - Country:US
Mailing Address - Phone:856-904-7148
Mailing Address - Fax:
Practice Address - Street 1:2500 MAIN ST
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1699
Practice Address - Country:US
Practice Address - Phone:609-895-2174
Practice Address - Fax:609-895-2056
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR12077200163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator