Healthcare Provider Details

I. General information

NPI: 1235517756
Provider Name (Legal Business Name): SARAH MORALES VITENAS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2015
Last Update Date: 08/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 FLORIDA BLVD SUITE F
WALKER LA
70785-7801
US

IV. Provider business mailing address

9775 HIGHWAY 190 SUITE F
WALKER LA
70785
US

V. Phone/Fax

Practice location:
  • Phone: 225-243-7716
  • Fax: 225-243-7754
Mailing address:
  • Phone: 225-243-7716
  • Fax: 225-243-7754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN134320
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP08222
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: