Healthcare Provider Details

I. General information

NPI: 1104483098
Provider Name (Legal Business Name): VITALITY HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2019
Last Update Date: 01/01/2024
Certification Date: 05/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10111 E 21ST ST N STE 315
WICHITA KS
67206-3581
US

IV. Provider business mailing address

10111 E 21ST ST N STE 315
WICHITA KS
67206-3581
US

V. Phone/Fax

Practice location:
  • Phone: 877-393-2492
  • Fax: 316-680-9915
Mailing address:
  • Phone: 877-393-2492
  • Fax: 316-854-5194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: SONIA SLABA
Title or Position: MANAGING PARTNER
Credential: APRN PMHNP FNP CRNA
Phone: 877-393-2492