Healthcare Provider Details

I. General information

NPI: 1669785812
Provider Name (Legal Business Name): WILLIAM MICHAEL VITALE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 UXBRIDGE RD
MENDON MA
01756-1094
US

IV. Provider business mailing address

9 INDUSTRIAL RD SUIT3 5
MILFORD MA
01757-3735
US

V. Phone/Fax

Practice location:
  • Phone: 508-634-6620
  • Fax: 508-634-6813
Mailing address:
  • Phone: 508-473-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNNP37557
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN230502
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN230502
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: