Provider Demographics
NPI:1912928995
Name:VITZTUM, COLLEEN M (CCNS, RNFA)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:VITZTUM
Suffix:
Gender:F
Credentials:CCNS, RNFA
Other - Prefix:
Other - First Name:COLEY
Other - Middle Name:M
Other - Last Name:VITZTUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CCNS, RNFA
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3000
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3693
Practice Address - Fax:816-855-1993
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119022363LP0200X
KS74527363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics