Healthcare Provider Details

I. General information

NPI: 1508434895
Provider Name (Legal Business Name): ATALIA VIETOR RN, BSN, CNOR, RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15060 S 39TH ST
PHOENIX AZ
85044-6612
US

IV. Provider business mailing address

9139 W THUNDERBIRD RD STE 220
PEORIA AZ
85381-4924
US

V. Phone/Fax

Practice location:
  • Phone: 480-332-7336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN193382
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163WS0121X
TaxonomyPlastic Surgery Registered Nurse
License NumberRN193382
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN193382
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: